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477PERMIT APPLICATION- <br /> BUILDING / MECHANICAL / PLUMBING / SIGN f PRINKLER / 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 57 I Z jeaV(ct, may PROPERTY TAX#: e,'d5'(v4.947'Z 003 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 5 co f-4- C'i wabev(e, TENANT NAME(If Commercial): N/A <br /> OWNER MAILING ADDRESS: STREET 571 5-CRY(au t <br /> CITY 6tioc STATE A1 A ZIP <br /> OWNER PHONE: (:z5) 3S1- 44,5-6- p / OWNER EMAIL: 5I a•w 3617 daily-v. Go1vl <br /> CONTRACTOR NAME: `)i -f bey ir * ,,,i(�1 <br /> CONTRACTOR ADDRESS: STREET IO- L f'( . (Zz� 3. <br /> CITY Lire STATE MIA ZIP /JO3Z <br /> CONTRACTOR PHONE: (41 uKfi— 3Z4G CONTRACTOR EMAIL: 6(p51/-Z�Lrit0vlti (PGHS''t•coiY, <br /> CONTRACTOR LICENSE#(REQUIRED): (.(ET J B 8610E CITY OF EVERETT/BUSINESS LICENSE#(REQUIRED O,/a i <br /> PRIMARY CONTACT: ❑OWNER El CONTRACTOR D OTHER(Please Specify) <br /> '-Ck <br /> CONTACT NAME: C CONTACT PHONE: ( Z — ,5G <br /> 7)�4 c� i 21441t yN CONTACT EMAIL: 4 1 /� <br /> Si] 7/444M4 l /►trot,6.97,-,BUILDING PERMIT APPLICATION <br /> Existing Use of Building: o(Ca Contract Price of Work:$ /Sr Off/, , <br /> •Proposed Use of Building: d 4& Heat Source: ❑Gas 0 Electric DOther <br /> Building Type: aiSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition EIRemodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Q <br /> • Y.em wlcP * rGy(acP Clad °` )S-r,,,a'� � � s7- f'T ' tifr'uc/( <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 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 /> Chemical or Water I No. of Heads <br /> • <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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> --� PERMIT# City of Everett Official Use Only <br /> W4(7 - r3t 1 5- $ , <br /> OwnerfAuthorized-AgentSt?nature Date (Revised 9/23/2016) //� <br />