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477- PERMIT APPLICATIOls <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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJ102ITE DRF�S4.:.t.� A Q <br /> nneC- PROPERTY TAX#: <br /> LEGAL for ewwcoconstruction: Short Plla`t/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Ced— CJ W klo(r?X'. L, TENANT NAME(If Commercial): �Nti,�' <br /> OWNER MAILING ADDRESS: STREET 9 c L 3(C ./ -L <br /> ./'( i <br /> CITY .11�SSc l/C y)II STATE 1--jZIP 9r7 7 <br /> OWNER PHONE: y'�S 5�.7 L 7'2 '` /� OWNER 'TP <br /> EMAIL: ht 1 a t)i�.� C: 4-cc, . ("4:2 vin <br /> CONTRACTOR NAME: �E\ iM c-C l(P!3(C c L_ Co , <br /> CONTRACTOR ADDRESS: STREET j K e q�.^ t� S _ (� <br /> CITY "� i <br /> STATE �./ r ZIP q ?-05 <br /> CONTRACTOR PHONE: 2- --.:.-? 7L. 73"1 7 , CONTRACTOR EMAIL: `(�Z^ 2,Uk.r-S Kc-y(A/Le -telyli c 2/ c <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER *CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: I ] CONTACT PHONE: Z C.3 5 7 Z 7 <br /> ..5" 2._f I Za�r2/l i'S / <br /> CONTACT EMAIL: ZEA A—, --i)K€4/`"r�--Cr'�►d/O,C�o/ o :7-err"( <br /> BUILDING PERMIT APPLICATION g� r <br /> Existing Use of Building: Contract Price of Work:$ (6O/ 1t(/�O <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 /> C t\2-vk IoW J C,„(4- L A 1 4--- N•9& COD Le r -,-- P. 2. z k c v',2,,,, <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 RangeDucting 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 1 <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 t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> r PERMIT# <br /> 1jSiIO4 Owner/AuthoriAgent Signature Date (Revised 10/12015) <br /> ____� t�z <br />