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0477- 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 INFORMATION <br /> PROJECT SITE ADDRESS:�O f-a. c f) / PROPERTY TAX#:O��1 D-A <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAMESr,e�{-�--PICL?c=��kqp,n TENANT NAME(If Commercial):6-� p o <br /> J i' JI <br /> OWNER MAILING ADDRESS: STREET7/OI tflt.r4ic' Y__;f�lj LAY(..74712_ ( <br /> CITY S74-4{1-e-- STATE �- ZIP 7 S-i I X/ <br /> OWNER PHONE: OWNER EMAIL: l <br /> CONTRACTOR NAME: I r`g___651n k1r 11. — <br /> CONTRACTOR ADDRESS: STREET DOiCC• Vevire° f_t-I <br /> CITY �e.1 t i (-5)- _,E.)- _,E. n'1 STATE ley A- Age9. C//� <br /> CONTRACTOR PHONE: ,0 �j7/- J 4J''� CONTRACTOR EMAIL:Lat- w -t- - 3l5(\P( • oes--r/(( <br /> CONTRACTOR LICENSE#(REQUIRED): 96:14) 605ry,(Yl CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (2(0 f <br /> PRIMARY CONTACT: ❑ OWNER 000NTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME:LC)Y"ie.--u'c \l r\* CONTACT PHONE: v -c-7 i I 3 c(3 <br /> CONTACT EMAIL: Lo,--;--e (Z; Ac _ s�( (y--; . ,( -5'(\ <br /> BUILDING PERMIT APPLICATION �- �" <br /> Existing Use of Building: C� iC(_t'Y.)) Contract Price of Work:$ .2 3,���`� <br /> Proposed Use of Building: �m yme. CA-cc) Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ,,Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:( -LWL'i:rabyLf\ k - %e 4- `J� � X91 5 U r <br /> c n 4 �c�l.� v.-ce C.L.• r' --der .,.- -ham ._s\ s t ler t ,r) <br /> rL f I -r,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.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 WAC. <br /> L -T,,,,, .. .-r_. Ili. PEit# <br /> r 1 City <br /> of Everett Official Use Only <br /> •. __ —.AlrA I E.!1111F AI aq( <br /> —Owner—.uthorized '•- Signature Date (Revised 9/23/2016) j/ '�1 <br />