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4577 PERMIT APPLICATIO <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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7 - -)'1T" FLAC_� 5,W. PROPERTY TAX#: 006,9 500000 1-500 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Ar'.IbQE-j I<L7FNISIC1-j TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -j - -�-1TN �j jGC 3.�. <br /> CITY E.1 EIZi�rti- STATE LDA,. ZIP 2,./Th� <br /> OWNER PHONE: (42 ) OWNER EMAIL: -PJ Pok:Irr�'1n62-o ,1v.A.\�. co✓✓� <br /> CONTRACTOR NAME: 1-Ic j OI.Jt-4E12._ CONTRA(---1 Ug- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: ('126) '13\ CONTRACTOR EMAIL: -R4 pc,Cr1-F-i� 2 e 1o.2 Ccc\ <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ® OWNER ❑CONTRACTOR ®OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C20(_) 225-cx.mC.oED <br /> lou �r15 �r� o CONTACT EMAIL: c <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: E 3t�C�c� Contract Price of Work:$ <br /> Proposed Use of Building: S tl_ Heat Source: %Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached ®SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ®Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: _ <br /> A t7 p i I t Dr...S.06\4_ :���M ATOS �&t 11 r-t.a row NpT1�---1 <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 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 omply withl the State Contractors haw 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> PERMIT# n <br /> y 0-1 . 2�-2.01-1 I O5 hJ <br /> Owner/Ayi orized Agent Signature Date (Revised 9/23/2016) <br /> �J <br />