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477- PERMIT APPLICATIO <br /> BUILDINAECHANICAL / PLUMBING / SIGN nPRINKLER/ 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: q 909 NA RBECK RD PROPERTY TAX#: 9/7000e9f 0202 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Per4.e J'TEi iltieffEA/Al) TENANT NAME(If Commercial): V4I- <br /> OWNER MAILING ADDRESSOF$TREET /0'2m w/�'✓`P SG <br /> CITY �17C/7/�% Z/IS/71 STATE a/o ZIP 9S296 <br /> OWNER PHONE: *ZS 4/22 OWNER EMAIL: fie%P—R f%ee4 COVOICq j/7/JG,r' <br /> CONTRACTOR NAME; d2144(46..4) <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 Z.OTHER(Please Specify) OFS/llv ' 4' <br /> CONTACT NAME: y4l,ycOv .1/4940X,eile.9 CONTACT PHONE: 206"2 fib 7„,3 2,9 <br /> .d9 ' y/_- CONTACT EMAIL: /3"449e y9Pyst€Pa-4Op. CO' <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ VSO.000 <br /> Proposed Use of Building: SPA° Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached XISFR-Attached 0 Duplex ❑Multi-Family-#of Units: El Commercial ❑Industrial <br /> Type of Project:.INew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: evikp 2sr DEy/ reepe,l41 se..'i'/y ,Q/�.f'G=iffEdeer: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: XNew _ Addn _Alteration _Repair Type of Project: X New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of f Fixtures #of Li ortures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units _ Heat Pump '/ Toilet Ba Preventer(Inside Bldg) <br /> / Forced Air Systems _ Unit Heater Bathtub inal <br /> Gas Piping _ Boiler Lavatory(Wash Basin) Drinking Fountain <br /> \// (7Va Rester Refrigeration .3 Shower Floor Drain <br /> Gas Fireplace Wood Stove / Kitchen Sink&Dispos ase Trap <br /> Gas Range Ducting / Dishwasher Roo 'ns <br /> / Clothes Dryer Hookups Other: It Clothes Was Medical Ga <br /> Range Hood / Water H er Other: <br /> $ Exhaust Fan / Sink ervice/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I 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 1 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 /> IC,C ;d7,J'er41-/ t Z40 Prill ULD (>316 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />