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4577 PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov 1 www.everettwa.govipermits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> a.o3c, rvielv�v. Prvt. CSO 5t-141700700400 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1 CA;ca&Q tkQ,ty TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET aa 3 vt^e1 L; . A vc �J <br /> CITY v.0 r (fir Wet . STATE ZIP y 5)„2 Q3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: JJWNER ❑ CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: -p.ro a,A/1,44 els S5a CONTACT PHONE: y P-5- 3 ys --S 315 <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S Contract Price of Work:$ I <br /> Proposed Use of Building: Sts Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: DNew ❑Addition XRemodel ARepair ❑T.l. ❑Sign ❑Sprinkler EDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: F K;SL. 10OLS a €&t, J fi c IIA i1 ow S'�PVc+VVCL, <br /> Ut$�" �V�IK Wo.11S <br /> �t tri �l S u L at1C al v�sk uA W 0.11. <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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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/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. I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> --- <br /> 3-a- /6 4t3--�._ <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />