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477 PERMIT APPLICATION <br /> BUILDING I 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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJE <br /> CT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3313 V Rt`-e_N /'i/n'I e � Fr V-er' 1') W!t PROPERTY TAX#: 0043/D 7 l 4 DD 70O <br /> LEGAL for new construction: Short Plat/subdivision 0ilk I� t k2- Lot No. (attach copy of long legal description) <br /> //�� CONTACT INFORMATION <br /> OWNER NAME: 0t.iv\,,sev— V4t.i iS'uY+. Uvr Vra✓jr'oti TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 0. 9u- t 11 4.7 <br /> 4i+• Cher, `Zu sem''p v cLLcnY i V'Q✓ e-1- /-1 CA)14 STATE W r�1 ZIP ' g-z.040 <br /> �� <br /> OWNER PHONE: 4 z- • ej (p 4 • 4-0 (p 0 OWNER EMAIL: r'►'2 € ( b kw tt i 12 • e.o ki•L <br /> CONTRACTOR NAME: t'ti# Yep- S,,/4 ded 1/01, IMf cot 4 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: /L CONTRACTOR EMAIL: C��j <br /> CONTRACTOR LICENSE#(REQUIRED): W!4 (1 C g 10 Si' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):C tc_/ <br /> PRIMARY CONTACT: igt i WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: .4�. 664/�1j• 4.i7to a <br /> CkN i s -- \,,,,,,,_(-, CONTACT EMAIL: Cly .0 ti c)n� l:0 1,0161 1 2 6 0/I-% <br /> BUILDING PERMIT APPLICATION / 1 <br /> Existing Use of Building: \)�,Cov..'- Lo-k- Contract Price of� Work:$ G 2 Z 1 0 SD (/ a-�ir-N.0 �d, <br /> Proposed Use of Building: �J1 to F ;L Fel)e(e•,*t r( _Heat Source: gi as ❑Electric ❑Other <br /> Building Type: ❑��SF�RR-Detached ❑SFR-Attached Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: I.$fQew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑ ign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: Cyt C.0,v RA-iv, 4- 5i 'a_w 0,-I. -pr Cons wL} 8� m `L 3^`•L tie, / <br /> C Z o;.t S W) _ _4-7 1 <br /> ig 1-ti- la a-- e rhe' .If- q 4,-a je 3 514-tA e -eA..°v'4 <br /> ASSOCIATED BUILDING PERMIT#(i applicable): nor Ft�„4 p(-44ee( p� <br /> MECHANICAL PERMIT APPLICATION / r 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 /> FixturesFixtures =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) r 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!complith the State Co actors Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> � <br /> �—��• 217PERMIT# -1lie�. DC� <br /> Owner/Ruth ed Agent Signature Date (Revised 9/23/2016) r\b <br />