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477- PERMIT APPLICATIO <br /> BUILDING I 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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: a 07 f' C a S t s1 o (2d f✓ £ c cur/ •Nan* PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): - I I( & — L(Zit))1 -'cIE <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: fi z «to f_ c( 6N cog Z /'L o5 GCr( (p N S t£-N <br /> CONTRACTOR ADDRESS: STREET a 01-- E- C A.S 1 ^'O f.d - 5 ( `,o e <br /> ,j U/ 4 <br /> CITY IJ Y E-1 /- STATE � <br /> I-LiJ . ZIP /d Q9 <br /> ci <br /> CONTRACTOR PHONE: (c 6') cj . /- (--o- 3 3 Co--/1 CONTRACTOR EMAIL:c ___/ !t Il is c fZ.0.La/a 44611 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify)Te Ni - <br /> CONTACT NAME: IG c?CONTACT PHONE: (3 b) 3j,- 6/2 3d' <br /> �L(p [`I �(Z- i!J ,-;dcz CONTACT EMAIL: -Cl(ii,jl�'G�l�( cLYN (Nd�Z 9— -tv ,CONI <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Ct^1 z Sher Contract Price of Work:$ 3/OC)0 <br /> Proposed Use of Building:artort //Ophy �(' -,�CYZ Heat Source: ❑Gas El Electric ❑Other <br /> Building Type: ❑SFR-Detached �� ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: giCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair OSign ❑Sprinkler ❑Demolition E]Change of Use <br /> DESCRIPTION OF WORK: <br /> ts> f M o u v a g EX/S. c;Jd .5'1�"�0-� , b�. r ( a ✓ E. rj t,S f�-o <br /> C� r 4-t w ,F(o ,f- <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 I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler t— 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:1 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 <br /> 2 toy CL <br /> Owner/Autho ized Agent Signature Date (Revised 5/20/2016) r\\1L <br />