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4117 PERMIT APPLICATION <br /> BUILDING �CHANICAL I PLUMBING I SIGN mimmiRINKLER I 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 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: S Z Br-0(40i Way PROPERTY TAX#: <br /> 1 a y I<PD-2_$OS-0700tO1-1/ 00 <br /> LEGAL for new construction: Short Plat/subdivision S S 12 -4)03 Lot No. L-1 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 'Maly- C 19-t-tir „ ! TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 CI Z•Z- r E Us4 5 I,N bol- G+t'.✓{. <br /> CITY �lrl;:i .�!a>G,( STATE w., ZIP -1(S VG <br /> OWNER PHONE: - .' Y OWNER EMAIL: o,.f-i'; r;>!: @ c, i i& } .( ost) <br /> CONTRACTOR NAME: y?/'(t"'r r 1. l . <br /> CONTRACTOR ADDRESS: sTREET <br /> CITY STATE - ZIP . <br /> CONTRACTOR PHONE: L/L c - '- ) ) CONTRACTOR EMAIL: i•d&if c t^'-t��l =cY ( ` <br /> CONTRACTOR LICENSE#(REQUIRED): ',‘ AL 1 E L 63 ZCj_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(7 3(. - <br /> PRIMARY CONTACT: grOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: / '„ CONTACT PHONE: - • - .� <br /> CONTACT EMAIL: I ,;. , ,c / U IA <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ C,°' BOG <br /> Proposed Use of Building: — R Heat Source: ZGas ❑Electric ❑Other <br /> Building Type: VSFR-Detached DSFR-Attached 0 Duplex ❑Multi-Family-#of Units: DCommercial 0 Industrial <br /> Type of Project: LslNew DAddition ❑Remodel El Repair DT.I. El Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> SFR ` (45 , <.. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> type of Project: X New _ Addn Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump j Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems D Unit Heater 2 Bathtub 0 Urinal <br /> - Gas Piping (> Boiler t-1 Lavatory(Wash Basin) 0 Drinking Fountain <br /> Water Heater b Refrigeration I Shower 0 Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal O Grease Trap <br /> Gas Range I O Ducting I Dishwasher 6 Roof Drains <br /> Clothes Dryer Hookups Other: I Clothes Washer 0 Medical Gas <br /> I Range Hood I Water Heater Other: <br /> L-j Exhaust Fan I Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> 'Number of Heads <br /> ACKNOWLEDGEMENT:l 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 1 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# <br /> / / 2,i„..t 1-- 11- 16 ey/b01 - 0 /5 <br /> OwnerfAuthorized Agent Signature Date (Revised 10/12/2015) \w <br />