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PERMIT APPLICATIOIy- <br /> 4.77 BUILDIN_CHANICAL 1 PLUMBING I SIGN ..INKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:57 05 EVer yYeen U. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision 10 Lot No. (attach copyof long legal description) <br /> ) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): /9/1 state. <br /> OWNER MAILING ADDRESS: STREET 57 05 ENierc3 I^ y Was 105 n �] <br /> CITY E 4ey e H- •J STATE J/i- ZIP -i V3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: E)1 x„T Sio Sex\/jc.@ig <br /> CONTRACTOR ADDRESS: STREET 1(.0U ciZ 8 i)-Fvevr-e- } -/-73(1 <br /> CITY m t I I ( (2e j. STATE W ZIP cleolQ <br /> CONTRACTOR PHONE: 1/2 S.33Q 8)(y ) CONTRACTOR EMAIL: bb"t 51 ns alsr) CO YVl <br /> CONTRACTOR LICENSE#(REQUIRED): 881-51 S 1 9D pQ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 5 5 ,O <br /> PRIMARY CONTACT: 0 OWNER JCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: iizs, 330 , <br /> R-01 rig. CONTACT EMAIL: f b-�S1�1i 1S @1y1 S n. coni <br /> BUILDING PERMIT APPLICATION <br /> Building: L'OrY)rr eSC(cp,J Contract Price of Work:$ <br /> ExistingUse of 900 <br /> Proposed Use of Building: 0/4 Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ZCommerciai ❑industrial <br /> Type of Project: ❑New DAddifion ©Remodel ❑Repair ❑T.I. sign OSprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> lri s+a l l ( ) caro C oj)nej k4er Stop ay <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project New Addn _Alteration Repair <br /> #of #°f List of Fixtures List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> 'Number of Heads <br /> ACKNOWLEDGEMENT:i have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.lam the owner,or am authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> O 00 4), <br /> Owns A -- ,.ed •gen, e �d/ Date (Revised 10/12/2015) <br />