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41 • <br /> 477- 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 FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: l yi 044 H F (Tr 1\vL/ PROPERTY TAX#: DO d{3 9\ 5 O 6 000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACTA INFORMATION <br /> OWNER NAME: (2.l)i HUtLicit/Hpri.es' P s c LL` TENANT NAME(If Commercial): 0CSD <br /> OWNER MAILING ADDRESS: STREET p,�, -B bX p��l.�r(j(p S <br /> CITY S eC. W STATE Lt..) <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: '3't7d<s(a 0 -p Lty v (13 <br /> CONTRACTOR ADDRESS: STREET <br /> 5 51()Q ' I-b? /\14E E <br /> CITY {`(�- tptZLt J V STATE W i ZIP 63 <br /> y(...J <br /> CONTRACTOR PHONE:. 7?S `7 o S -°SSL 1 CONTRACTOR EMAIL: ID('obk'(C'e- p L(.t.vvi t Yi' 4 C_o` <br /> CONTRACTOR LICENSE#(REQUIRED): I4:0,‹pp Q 7 3 1_7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ' cX�l 0= ' <br /> PRIMARY CONTACT: ;:OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ""f D- <br /> kk_e. - A o if s-m-) CONTACT EMAIL:Vt CcA45 C� Q (Z'� C.t.kit <br /> BUILDING PERMIT APPLICATION /I <br /> Existing Use of Building: Contract Price of Work:$ I'c ri p0 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric El Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial ❑Industrial <br /> Type of Project: CI New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: l7� �/�0� / �p� <br /> 1 VV �v�I 'll� `s J2 d `a <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 f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler I Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration I Shower Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: 4 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 1 No.of Heads <br /> ACKNOWLEDGEMENT:1 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.1 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# 0 \--( <br /> 60 <br /> Own /A thorized Agent Signature Date (Revised 9/23/ 016) <br />