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4677 PERMIT APPLICATION <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 /> //1� PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:54,92`, it ,,,. i�cu,� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision i� Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: .titl'k ,1 t€o C)r.V1uck P:S i f;:T TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET c,a.44.4?.. AS C-7>1 }e✓ <br /> CITY STATE ZIP ,, <br /> OWNER PHONE: 1-12,.5--3 I- 13,---;v OWNER EMAIL: 5.4-e n4 ct%.UAL/ Oda/t�'jj,L�&in tack <br /> CONTRACTOR NAME:_ e_ r-) Am%a:„. s1P4 ra <br /> CONTRACTOR ADDRESS: STREET q 00 Our orA Ave- A) <br /> CITY Sgh-Tnt, STATE 41/14 �\ ZIP 98/Via <br /> CONTRACTOR PHONE: /��-91-2,-::-?-113& CONTRACTOR EMAIL: ,'�1 i 04'`- /- ?J•fP�7`.% me/MA cM Oi4 '—' <br /> CONTRACTOR LICENSE#(REQUIRED):7J£(-T4R o5D 1CITY OF EVERETTBUSINESSLICENSE#(REQUIRED):O k cCJ$ <br /> PRIMARY CONTACT: 0 OWNER 'COCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: ., �/ CONTACT PHONE: 206,7 -)r-1-.2„--5`613( <br /> Kj t,V (YrMf�ker CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:G - ee,/WMe..htu..i Contract Price of Work:$ %Cfei S UO V° <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <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: <br /> ke cover ever €41 r711/G roof $yi 7.erti 141,)1i, Cov'cI(-" )a dcl <br /> fooF'Arg, <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 /> 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 /> 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 t State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /��.d7 f ✓yl L'ii.--- ---, �� / PERMIT#II �� ' U 1O(iv er/Authorized Agent Sign Date (Revised 10/12/20155) ` e <br /> / by <br />