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• <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 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only please)' PROJECT SITE INFORIVIATION <br /> PROJECT SITE ADDRESS: /600? h W /// 64 f, PROPERTY TAX#: 006 c 9‘gy3 CO/00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> L // CONTACT•INFQRMATION,, <br /> OWNER NAME: s o /d/{-, t 4/ L �/ . TENANT BUSINESS NAME(Commercial): `�i�/d / /�, 4 <br /> OWNER MAILING ADDRESS: STREET -26 CJIy <br /> � f y /�e r <br /> CITY 2/C-"Gs•// STATE (1.-1/ ZIP 9$20/ <br /> OWNER PHONE: y7$ „25o? SS'Ot OWNER EMAIL: <br /> CONTRACTOR NAME: WO/ <br /> CONTRACTOR ADDRESS: STREET f73 R 7' S7' � <br /> CITY Okie2nroe_ STATE /�4/ /� ZIP G D/ 7� <br /> CONTRACTOR PHONE: 366 -2 9 y-FC / CONTRACTOR EMAIL: /1!l c'/9 i.ap Jf&p, <br /> CONTRACTOR LICENSE#(REQUIRED): /10[ / a Z�CV CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 3024 VC) <br /> PRIMARY CONTACT: ❑OWNER OrdONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C/2j^ 38 7_ /a� <br /> a / � n till 2, )9 CONTACT EMAIL: ill/ /962J t,0//� rrl <br /> .' BUILDING INFORMATION sn <br /> Existing Use of Building: es./yj /71 Contract Price of Work:$ 4O, <br /> av <br /> Proposed Use of Building: U)?tom Heat Source: ❑Gas DElectric ❑Other <br /> ❑BUILDING USE: ❑SFR Townhouse ❑Du 0 plex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition LifRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> gnu Ait) 4'4d ,?) s i //7 C(.) ,iteiot - Sao,,,, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL,PERMIT A0.1*0001:01 PLUMBING:PERMIT APPLICATION . <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher / Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> $PAINKL4R I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System ( 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!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 /> 0,/�2 � OrLA <br /> Owne tho Iz�gent Signature, Date (Revised 10/10/2018) <br />