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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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:38/$ Ste, i /5 ("/1 203 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. / (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:. 6Lh ,c avr I i' -lift <br /> lin-(J TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6 <br /> cITY ref STATE IV71-- ZIP ?p 2G? <br /> OWNER PHONE: RbC "7ct3 .5s-?....7 OWNER EMAIL: , I..Ke.vtN-tat 'new(,., 5•t • (C34' <br /> CONTRACTOR NAME: .,If r <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:,,t OWNER ❑ CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: 2:16 .. (a' s15-20- <br /> -JEAN{r\ KC Vtv mac,(7 CONTACT EMAIL: ( �/'.�rre r_iu. -, _Co <br /> 7 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> rr <br /> Proposed Use of Building:J ill it if en it Heat Source: JGas ❑Electric ❑Other <br /> Building Type:t,t�fBSFR-Detached ❑SFR-Attar d ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: I Jew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 5yer u✓l r,..,..,3 -14,0 51-beti 5.v‘ tc <br /> cyrn,fesX • S 00, 5f ?Ls 0.1),...ts,f 3 cayc yar <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 <br /> List of Fixtures #of List of Fixtures #of List of Fixtures 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 /> t/ Gas Piping — Boiler Lavatory(Wash Basin) — Drinking Fountain <br /> ZWater Heater Refrigeration 3 Shower Floor Drain <br /> Gas Fireplace -- Wood Stove / Kitchen Sink&Disposal — Grease Trap <br /> Gas Range Ducting L Dishwasher _ G _Roof Drains <br /> Clothes Dryer Hookups Other: I Clothes Washer — Medical Gas <br /> / Range Hood X41 Water Heater Other: <br /> if _Exhaust Fan f Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Pa Chemical or Water I 4t1, 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 wjth the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> // City of Everett Official Use Only <br /> /.1,t4 <br /> 0/7/� PE # <br /> �RMIIT•iL50 0 <br /> n Aut orized Agent Signature te (Revised 9/23/2016) _ <br /> ' it <br />