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477 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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> -610 Orr WA <br /> PROJECT SITE ADDRESS: (7),t ) CA12J, f JI)-J# ol,�.,G I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: G�� Ot It(l TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET a,) (jcK /-j G'hitet l (' <br /> CIN eUf kir STATE ,k'f - zip 9act.-- ---_. <br /> OWNER PHONE: I.iJc v I OWNER EMAIL: (_ r()) @ t 1( k09l1'fefr , Alt 1 <br /> CONTRACTOR NAME: 5 t 4V <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: .56-10V1 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Gr�5" 5G f (I°5-- -1 <br /> CONTACT EMAIL: 6 (c: ,AI i.0e n44,ortc,r NQr <br /> BUILDING INFORMATION <br /> Existing Use of Building: (_, prfr-pi( -- co c r�!4.,,,r, h'ittA4Contract Price of Work: $ '-� <br /> Proposed Use of Building: \ �f d Heat Source: OGas ❑Electric ❑Other ]L'o s-\)e <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU EMulti-Family-#Units: ❑Commercial ,,1E7Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler Qemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> (<P(/'' Cv 1 / I I� 4-41 /0\ ;Z 67)4(75-6 C <br /> ASSOCIATED BUILDING PERMIT#(if applica.b*•)' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 'No.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 I comply with the State Contractors Law 18.27 RCW and 296.200A W C. <br /> City of Everett Official Use Only <br /> 3 1 ri <br /> PERMIT# ®3 y Oo5 <br /> Own uthoGized gat <br /> 4 Date (Revised 10/10/2018) <br />