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4477- • PERMIT APPLICATI• <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 /> ^w� Do ac opc)© 9 3 d e <br /> PROJECT SITE ADDRESS: "l9OO ��C+ 1 PROPERTY TAX#: 0m'/`t15Be�s 49 st a <br /> LEGAL for new construction: Short Plat/subdivision i4u X'd <, S/7=r f'v Lot No.17-95(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: V/2 4 C.. - TENANT NAME(If Comm cial): Ve,e4 s <br /> yk 'DI E (Jk k — 00 <br /> OWNER MAILING ADDRESS: STREET oo' P QC W e °� r" <br /> CITY .-r am STATE IA? <br /> 1--' ZIP -.7 <br /> OWNER PHONE: `,%''5." vim'`• y cc- ,,: r <br /> '�t'` :r' � OWNER EMAIL: ��� %�<� `�"'6 s� &, <br /> CONTRACTOR NAME: • d k-/ I A ,C'erYlv5° -r- .14, `/ <br /> CONTRACTOR ADDRESS: STREET / ''3 Uz/ R s„r- A/ ''e'V'-/ <br /> CITY SA-'..e.(4.G,-'"cot,'', F.t A'` STATE t't X' ZIP 55,'''). <br /> CONTRACTOR PHONE: 3ero 3 CONTRACTOR EMAIL: i 4.14715 dj rZ 67°V X7,4/04) , t :1 <br /> CONTRACTOR LICENSE#(REQUIRED): 4 e. (C y-W5'dd 3 C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED <br /> PRIMARY CONTACT: TI O4 WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:— ' y-' ..- •3 VS, 3 2-5,-- .4 <br /> V/2 474. CONTACT EMAIL: , .( roil giroV ., <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: / ` Z4.1)-' Contract Price of Work:$ 94+r °� <br /> Proposed Use of Building: C it •-- r A 4441d ,0L:1" e,.5 Heat Source: Peas EIElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: IiCommercial ['Industrial <br /> Type of Project: ONew ©Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ['Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: e z.- ,, e.,?5 Ce'eA/,,t F'4=:..-` .F E�` '/ , <br /> al l tt63 *iv eSacb vt. aviAn4,,ctoicalrovv, ` <br /> ASSOCIATED BUILDING PERMIT# if a licable : Tal'L1!7 � 'l (4 r d'l1�f T 1 �� A) <br /> cpp l � oa �l � -F�c ��h � � 6 <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 #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat,Pump '• Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> 13 lam" <br /> Gas Piping yp 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 Fah Sink(Service/Bar/Mop/etc.) Other: _ <br /> i lJ OW-Tr-trS t 4-Ielic'C .1 `.TS _ <br /> SPRINKLER I SUPPRESSION SYSTEM A - <br /> Z Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and c rrect.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 /> .:•- ;= ,,�s / til PERMIT#6 t rl <br /> 'C2wne1'/Authorized Agen`FSigttature,7 Dat (Revised 9/23/2016 VA , <br />