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4:77- 41110 PERMIT APPLICATIOS <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 PROJECT SITE ADDRESS: 4 6 a 3 I C r PROPERTY TAX#: it 07600 q00 ty <br /> 6 O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION _ <br /> OWNER NAME: \,c..t,,,,,L\ vAo.A.{ ,...4 / U . t\\. ENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET l&r,2 l� c? ) q /y��(� <br /> nnJ f r CITY aVwo s STATE ()4 ZIP `14�s. <br /> OWNER PHONE:rrWC g1Lr J [ 0 y OWNER EMAIL: f 0c1-�E..n 't Q C � ,( , C¢s.v- <br /> CONTRACTOR NAME: A ! `l <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 ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:((it•/l t C3f-e..e, l (Mpl/..-Va CONTACT PHONE: Doc q ((4 3 7Q <br /> \..�.tr, yt,.\`.LJt . 4 'v-gi„6 -oc)0 CONTACT EMAIL: Ktcl-4r,,+,,..-- e ( �•t„t•'. c — <br /> BUILDING INFORMATION J , <br /> Existing Use of g C7 ,'P Contract Price of Work:$ 1 560° . <br /> Proposed Use of Building. G. Heat Source: ❑Gas ectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DU ❑Multi-Family-#Units: ❑Commercial ❑Acces ory Structure <br /> Type of Project: El New ❑Addition El Remodel El Repair ❑T.I. El Sign El Sprinkler ❑Demoliti - .range of Use <br /> DESCRIPTION OF WORK: tti rat <br /> f I <br /> Re mode/ flea 5Fi ig-6c _,!-7._- : - , Atd 0co4641 s-2 . <br /> J <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures List of Fixtures <br /> Count <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/InserULog Roof Drains Water Heater <br /> SPRINKLER/'_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 be for 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 corn y with t State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 1 City of Everett Official Use Only <br /> :Ate( <br /> trPERM11 Oo —Owner/Authorized Agent Signature Dat ( (Revised 10/10/2018) <br />