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4:577--fir PERMIT APPLICATIC <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 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: '2 45 v PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: bt-vv-\e71U1� Q_`1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET j2lc) r Ave_ <br /> CITY � Vim- STATE �1•'\ ZIP 91)2-o) <br /> OWNER PHONE 2 N • 410-2- L�- <br /> >,I,p� Y <br /> OWNER EMAIL: )9C-Me Cd YYlco —y ne.� <br /> CONTRACTOR NAME: Tv)C VGi YIc - <br /> CONTRACTOR ADDRESS: STREET j )?�, M -- SC.- <br /> CITY �f,/( i"1 STATE � ZIP "2-c;`3 <br /> CONTRACTOR PHONE: <--{2.-s 33-1 01345 CONTRACTOR EMAIL: I yt.c . ne 1- <br /> CONTRACTOR LICENSE#(REQUIRED): ) )¢..yc,) ci!z pet N CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):C 2-3 j, <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Li 2.5-?DebI Jam-)Gj <br /> ) \6.v v,nCYL- CONTACT EMAIL: �Vl�ci Irri vtcAcc Y> , r'll'-_ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family4 of Units: DCommercial 0 Industrial <br /> Type of Project: DNew DAddition ❑Remodel DRepair DTI. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 fa'LRepair <br /> #of #of List of Fixtures List of Fixtures #°f 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.) 1 Other: <br /> SPRINKLER I 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 ' the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ";,_, <br /> 61)1 \Cp. PERMIT#p1 / _ O% <br />