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417 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 I (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: jCF 2.5R E-tz //Air" • PROPERTY TAX#: 00Is !4(i r2-O)ZOo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:1)1Aivot4p V -(f.„?..114k12..( MocAXM5 TENANT NAME(If Commercial): DtAm( D kilisr lw-'[ Cud!L <br /> OWNER MAILING ADDRESS: STREET 36 g-ut,K R„ kve , ��/ <br /> CITY Lyyyy��rVViv-T'� STATE WA ZIP 8'006 <br /> OWNER PHONE: 4Z'537 & - 1579 OWNER EMAIL: f km i-i-c1/lc..-1 ( <br /> l( alfaworld vc (- <br /> - , D kvi <br /> CONTRACTOR NAME: gD ARAAALUACt ( 1J Qv,/ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: /� .o CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):f ?(k)t--`� (s_ 7 -71-' LO CITY OF EVERETT BUSINESS LICENSE#(REQULRED): 1065 <br /> PRIMARY CONTACT: 0 OWNER ❑ CONTRACTOR MOTHER(Please Specify) Ago-II-m.0- __ - <br /> CONTACT NAME: IA41/-ESWA14<eg- CONTACT PHONE: 42 -2'.7 G06&,5(/OT£SCI4-, /)tA- 1L AAP- A' ala-W-rs CONTACT EMAIL: i/ViiJam?C1 bkll G.ve..14 - cowl <br /> BUILDING PERMIT APPLICATION ---\ <br /> Existing Use of Building: VETERII4Ag' C/-I///L( O5,,JS) Contract Price of.Work: $ SOS, 006' r <br /> pBuilding:VkysRlt.l4V-1 GllnliC slal�5� <br /> Proposed Use of Heat Source: LZas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑S�FFR��-Attached ❑Duplex ❑Multi-Family-#of Units:---` -- E Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition L`1Remodel ❑Repair ❑T.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: A �.� opV OF A/105-t- Of 7- F/R -r Ft O E OF <br /> 774 - �x / T-/pJ& f'c ItFr '-Llflic To ,itkLvj7 NOrJ- 6AgiNc�1 w4L,Ls, /\l k/ <br /> 6iit;IWW6is, /YEw wi lo0.ws 44r7 k 8o sF NI TRY Acv. r(c t4 . <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 #of #of <br /> List of Fixtures <br /> -List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Ij2at 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& I .o - Grease Trap <br /> _Gas Range Ducting Dishwasher I Roof Drains <br /> Clothes Dryer Hookups Other: Clones Washer Medical Gas <br /> Range Hood Wate •.ter Other: <br /> Exhaust Fan Sink(Servs - :ar/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 /> City of Everett Official Use Only <br /> ..-- 7,../;7/4._______ PERyit <br /> Z'MZ <br /> nO(CD — inCO <br /> Owner/Authorized Agent Signature Date / (Revised 9/23/2016) ,-- <br /> 4 <br />