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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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATIONT <br /> PROJECT SITE ADDRESS: 422.0I aZ ST S If- <br /> C i'e W�'/�"OF pROPERTY TAX#;a$05(900.3025 on <br /> LEGAL for new construction: Short Plat/subdivision Lot No O ' (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Kp\{( (,te_ 1.`0 mQ f TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7 L4 dL 5E ,v144,-% S a <br /> CRY(Apt-C 9f '15STATE w / y <br /> A ZIP O� (� <br /> OWNER PHONE: was-age -4„&g.6 'OWNER EMAIL:C A` 1 •C0 M <br /> CONTRACTOR NAME: O t� S\ c jcleC� <br /> CONTRACTOR ADDRESS: STREET •-p• © . %OK 115 <br /> CITY STATE 'Av OX ZIP 9 o Rs <br /> CONTRACTOR PHONE: 4142-rj -p � I-[,,(oat, CONTRACTOR EMAIL: c... INemQ,,1 a c�laG <br /> 't . dIVI <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER VICONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: q <br /> eNracl G'eo�e\` CONTACT EMAIL: C p,qy �) I CJq a%l 1• on <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$_ . <br /> Proposed Use of Building: Cal-?0c4 Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: CI New ❑Addition ❑Remodel El Repair ❑T.I. El Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ZA (X\ Co 1?O r'))" kO ' elv <br /> tN�W �A���YV����W� rV <br /> tivArW o.0,crut,e.c <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 List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-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 /> Chemical or Water I 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.1 am the owner,or l 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 WAC. <br /> City of Everett Official UsejOnly <br /> PERMIT I sit) _0,1to - 2H - i ? <br /> Owns uthorized Agent Signature Date (Revised 9/23/2016) <br /> 4, wKe,+-• 3 <br />