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477. PERMIT APPLICATIO <br /> BUILDIN�VIECHANICAL / PLUMBING / SIGiRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 q—(? (' <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> OJECT SITE ADDRESS:1 3.2 I�-OL6ci �� cJ —7 PROPERTY TAX#: oO 3 LI (0 / ` 0O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: c5tc5a,.) e..0,t//2p� 2 ^^T--EN__ANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET J( 3� C6z(5 A-&-e <br /> CITY STATE [Ai ZIP ‘20I <br /> OWNER PHONE: 702-,2-3q•—/q,s7 OWNER EMAIL: `� <br /> CONTRACTOR NAME: Dil/ �,I�JD N/-,-,e �LaJ 1 1-3,,,,.06.- ( /- .ca7-14u -- <br /> CONTRACTOR ADDRESS: STREET v /1-f' 1,3A 44' _ (� . / ' , /� �j/� <br /> CIN Lr N A.)� )J STATE UJ A— QQ <br /> ZIP � 3 7 <br /> CONTRACTOR PHONE: -'1 TS- ,C/ I( CONTRACTOR EMAIL: 302464,\I ie,Q DA.)11-6 0.0{— <br /> CONTRACTOR LICENSE#(REQUIRED):DAVA PItqN1-1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): dig7 14 I <br /> PRIMARY CONTACT: 0 OWNER gCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: z4Z5�?7�� i if <br /> g'AIA-Ni CL- CONTACT EMAIL: j)I t /'TN.0 a -AP-C-4 <br /> BUILDING PERMIT APPLICATION <br /> 111 , <br /> ting Use of Building: Contract Price of Work: $ q00-COoposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: /Jii. uA/ Ai-&t.) 671- A/0,Ai -7-70 Ke-rt-i ) jJ , , 1 LcCkTk ,3 <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 #°f <br /> List of Fixtures #of List of Fixtures #of List of Fixtures 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 /> pOWLEDGEMENT: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 /> nt 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 /> udding 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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 40 if <br /> / J., -7 , PER #� (a04...._. no i <br /> Owner/i u oriz:: Agent Signature / P Date (Revised 10/12/2015) <br />