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f 47-7- PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN I 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,. rr; u1 PROPERTY TAX#: - 4. , yv! <br /> '0.-----, <br /> .-vim # AVO 5u104'0 v 3 / / <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) _ <br /> CONTACT INFORMATION <br /> OWNER NAME: S57(CD Lvmioa.5A1..e. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET re i4' 0017n - <br /> CITY f/SJ4Q11r-�f i- 4 STATE ZIP 9 &- - <br /> OWNER PHONE: 4/11<- 3/5 (t-,-.7--.2 OWNER EMAIL: ?Ls 4,/dh/r'GrM ee05-74C7,Co%'1 — <br /> CONTRACTOR NAME. _5,r1/ja f//ZC SV/ST h75 <br /> CONTRACTOR ADDRESS: STREET //a(' 52/4 4vE E <br /> ..�1 ,�1 tom, <br /> CITY 7xlefore1A STATE kja, ZIP JC Z��9/ <br /> CONTRACTOR PHONE: .753—0440— O Ss--- CONTRACTOR EMAIL: ///.)4,44..5M'-k`Ani'e-•wit‘ <br /> .4 — CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 2-_"v., .;;7--7 <br /> CONTRACTOR LICENSE#(REQUIRED): 61)1��13i L .._ <br /> PRIMARY CONTACT: 0 OWNER ( CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: z is/iL /j/,;/0,..4.< CONTACT PHONE: (.25-3_ay,. 'a0 /5 <br /> CONTACT EMAIL: ///1/tet5 ?5M4/f( es .0 ,1, <br /> BUILDING PERMIT APPLICATIOND <br /> Existing Use of Building: 16 re Lid/(/ Contract Price of Work: $ ,S (j��//7 <br /> Proposed Use of Building: i -iU4-' Heat Source: ❑Gas 0 Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: DNew DAddition gRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler Ill Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: yvypp/r/ megx'S17N&- 5PRIrt-'kJJK.SY5'IDVI twor1biloa'iTE <br /> 7tJE'Vlw 1,-4341, a/Qit/k,A11,'P LODLE/Z. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): J <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> #of #of List of Fixtures <br /> List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures <br /> 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 /> /v 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 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. City of Everett Official Use Only <br /> PERMIT# (410 ���` <br /> Owner/Authorized Agent Signature Date / / (Revised 10/12/2015) <br /> \12.... <br />