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477 PERMIT APPLICATIO <br /> BUILDII7 i I MECHANICAL/ PLUMBING/SIGN MPRINKLER/ 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 /> PROJECT SITE INFORMATION <br /> PPA TSIF ADDRUSS;,,.., (1,..,, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Eve SLI ‘-k,NA.STA C Il „�©{ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET'3�°V1 C .6‘0..i ,1 <br /> c Y 1�JQ (2)}1 `-''i� Q STATE Lc 0- ZIP /// I <br /> OWNER PHONE:Loa P``\\ OWNER EMAIL: <br /> ............. <br /> CONTRACTOR NAME: �Oy\1 i(\ ,,\\r,Clyv c., '=R� \(j,\ ON CJ <br /> CONTRACTOR ADDRESS: STREET P, ,, E'h.. \ire) <br /> ► + cCITY Q STATE . iA , zip 9(89 911 <br /> CONTRACTOR PHONE:4'�JQ 93 1 CONTRACTOR EMAIL: '�;\o?0 ‘ -‘1\Q, 1i`^ \ . 6C}K_.t <br /> CONTRACTOR LICENSE#(REQUIRED):`ZZia.**0 tAtle. \ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): b5g,31(e, <br /> PRIMARY CONTACT: 0 OWNER NONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME�6\� `\\\ 001\&C' <br /> c CONTACT PHONE: LA'avb g\G (4 39 Li <br /> w CONTACT EMAIL: •.ci v, <br /> t.\� � <br /> � t' 5am,iv._. c . <br /> , ((�� \\\ BUILDING PERMIT APPLICATION <br /> Existing Use of Building: {A�:�7t s • C',..m\\\� �`� . Contract Price of Work:S4-7 �1) t, -_ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex aMulti-Family-#of Units:Li Ole : ❑Com mercial ❑Industrial <br /> Type of Project: El New ❑Addition El Remodel ikepair ❑T.I. ❑Sfi(q�n ❑Sprinkler ` ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:rQ.,G© \,D`T4cc n <br /> . c..W2.°.ZS;Ci.XX 3C)I is• 1-4.41/4-k%4\r;.L0-.,LGE1/44.9 tai/ \ t 12 <br /> v\“.A 5, S vet Sk..vr\../' \t °-Vkcc.c c \\ 4.46‘..N..+�.C, 'J-" <br /> 't L Nom{ ‘ -0-,A6%sk i1n..`GL,Icc. J <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 /> NC—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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> nd I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> k(l_u <br /> t/\I I q A ' iS PERMIT# -6 ( (z__ 02� ' <br /> Owner/Authorized gent Signature Date (Revised 10/12/2015) <br /> -`'l2 <br />