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477- PERMIT APPLICATIO$ <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 /> PROJECT SITE ADDRESS: l63¢ „l6//1/47 4'VG PROPERTY TAX#: DUI- 7/6 503CDD <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: NF I'✓ Ar(1✓i?/Z//0.0C/ 5 A5 dC J zze TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /'O ..gc?X 22Z8lo <br /> CITY -SCA//GE STATE WA ZIP 9 7ZZ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: b (Ay 1-4.4(21c,[I �(01.sM� • <br /> CONTRACTOR ADDRESS: STREET Z Z�b 7 1 1 l° 4' <br /> CITY I ld r i I' )X, STATE W'-t • zlPgo /O <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) .f • <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR EKOTHER(Please Specify) ACC-h/iT.EC% „ <br /> CONTACT NAME: CONTACT PHONE: 025) "2 - ?zOa 1 1P1,0" ) <br /> CONTACT EMAIL: ii'J?le/sp�SS"/r,vlO ELS'rye/ci 4o1mQ r/. CG/i( <br /> BUILDING PERMIT APPLICATION ✓ <br /> Existing Use of Building: G1)r,7fnee-c r re..5/JC 4 'r 6(/ Contract Price of Work: $ / d°U O U <br /> Proposed Use of Building: -- Sammie Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> P4/4-SL-" ON j'ee Lt Ve4 i& C7'e-"t'j /)CT vt f 4/v1 C'ti/ 1-44 <br /> �, <br /> 0 <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 /> Gas Piping 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 Fan Sink(Service/Bar/Mop/etc.) 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 1 comply yvittfThe;'ate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> / / L(pao— D32-- <br /> Owner/Authorized Agent Signature Date (Revised /20/2016) <br />