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477 PERMIT APPLICATIONAI �p� <br /> BUILDINt ECHANICAL•/PLUMBING /SIGN I INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE''INFORMATION: <br /> PROJECT S TE PROPERTY TAX#: <br /> r,l'�D' t to r A�� C oS-t 3ct►oo <br /> LEGAL for new construction: Short Plat/subdivision Lot NO/2..3 (attach copy of long legal description) <br /> ;CONTACT-INFORMATION;; <br /> OWNER NAME:—Mkt g IfjIrf IW ,5 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2O 7(kt (At f pot, <br /> CITY go -n- STATE (rp if} ZIP etiabS <br /> OWNER PHONE: Lizs...530 5 3 OWNER EMAIL: LE0G it r0 HCO 'COO-1 <br /> CONTRACTOR NAME: ©Wta, <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: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 0 W11tZ CONTACT EMAIL: <br /> BUILDING;!PERMIT APPLICATION <br /> Existing Use of Building: GP it_ Contract Price of Work:$ O" 27, 2 t° <br /> Proposed Use of Building: 5Fe-- Heat Source: El Gas DElectric ❑Other <br /> Building Type: 71.SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition TiQRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: c„lJle,_n-7 �,,C 07//C/(i , 6 G'= //pia G/✓I'16 Se4O-E ("W SA) <br /> 114.44o(91L ea I i/A)4 $ od"s <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 /> I Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> I -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: lothes Washer Medical Gas <br /> Range Hood W Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) 41 Other: <br /> SPRINKLER/_SUPPRESSION SYSTEM`. <br /> !Number 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 /> PERMIT# a t UQ 2-6,0/) <br /> Owne ed Agent Signature Date (Revised 10/12/2015) <br /> ,'2 <br /> 1 <br />