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4.7.7. PERMIT APPLICATIOP
<br /> BUILDING IECHANICAL / PLUMBING / SIGN IIIPPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<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 /> PROJECT SITE ADDRESS: PROPERTY TAX#:
<br /> 202-\ lroc-\ AJ E O043-f -13-42-CL4o0
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME:Aa ELuS+v( lp t�Sof\ KAk "----Zen TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET &OIL L LA4' Sj- E Q
<br /> CITY `SYN-O V-O ON 1 S 1r� STATE 1.'3 IN ZIP { O 9
<br /> 0
<br /> OWNER PHONE: t\7 - 3 -j y'LLo OWNER EMAIL: ky\t 0.v 5\nE\\ ' yv\U‘\• CIYI
<br /> CONTRACTOR NAME: Ow V,_&
<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: IaOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: 610A S-�urluu ovO , CONTACT PHONE: Mall- ,'Zs S-°J_y�J4C ,/e
<br /> o.-
<br /> JyZs'�a7 sy<
<br /> is le gelJ CONTACT EMAIL: Q..he,, J sfi.,4u eo-k.
<br /> ✓ (So6.i NC. ,,ovt.._
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: 1 r-: \e__,/. - (.._0, evne,e.,6 Contract Price of Work:$ NA
<br /> Proposed Use of Building: \ .oe_� Heat Source: ❑Gas IZIElectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex E'Multi-Family-#of Units: � ❑Commercial ❑Industrial
<br /> Type of Project ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler IODemolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> b,AtA..1,,,,, 0C (-i-a,,,\ G-il.ci s, e_ ?c,C.h -trc k\A'•v- oC'c_'- C'Doc - IQ ake.: o
<br /> � -1/4.. cti\\.. \-.1/4:_k,-11-',0,,,, ,, ,A be._ W\cr.A e 4 e- C.c r.s t-(`x!Ll,c p it e,,,) 7 tom,cs k\ 5 k,at,.h
<br /> C -1:\/\Q___0 - 0,v`.8. ckev:0I;-5/1 reu- deck_
<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.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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> �� -' PERMIT# C�C�i(� 'l.l�) I
<br /> ,--
<br /> ..".2,„.`"4--'< 1 %���___ i -r vim`
<br /> ner/Authorized Agent Sign?tuje Date (Revised 10/12/2015)
<br /> Nil
<br />
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