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477 PERMIT APPLICATION <br /> BUILDING I MECHANICAL / PLUMBING / SIGN i jr RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION ll <br /> PROJECT SITE ADDRESS: 2 b` Z/S-� �y PROPERTY TAX#:(70 5.5 3/0(_CG�j‘7110()l(/l'0 <br /> LEGAL for new construction: Short Plat/subdivision _ Lot No";✓cF (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Sce,-p-}- ( ,r~f Sr7,\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7,6510 -/5-/- 522-- <br /> CITY/ Vere-;�-'? STATE(JAI ZIP /8 ) <br /> OWNER PHONE: 6- 'Z, d -35o3 OWNER EMAIL: GG j 0/( 1.,_S 4dA'• <br /> CONTRACTOR NAME: �-L� rsor\_, <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR © OTHER(Please Specify)4(,y,,er At-�j�7v� <br /> CONTACT NAME: t7� ,� � CONTACT PHONE: /�� <br /> CONTACT EMAIL: rte, vPI\G'GS Hccm,k, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: j7e<a,r -}' Contract Price of Work: $ <br /> Proposed Use of Building: .0G //S'/-?/ Heat Source: ❑Gas DElectric DOther <br /> Building Type: 1E1 SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑)T.I. ❑Sign DSprinkler IY�Demolition DChange of Use <br /> DESCRIPTION OF WORK: D "O/t,.l,io'ti �g DA-D( lit, <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 #of List of Fixtures #of List of Fixtures 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.) Other: <br /> SPRINKLER/ 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.l 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 /> C/T-L- D 1 (0 <br /> Ow uthorized Agent Signature Date (Revised 5/20/2016) <br />