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477 PERMIT APPLICATIOIL <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 I(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> K /,��c.. eto - 004 315 1'°1 I0d1d0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: lfn.SO i> 135 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 30 [q V.1, � . <br /> CITY Q,{`'(4-i STATE 1/314-. - ZIP -I gam <br /> OWNER PHONE: (ROU) `��2— 19.5-3 OWNER EMAIL: trn (2.+ti is FjrD L „euyyk <br /> -CONTRACTOR NAME: I7turvy' J <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: M OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 9,00 Of I — 25-3, <br /> -IAS011' SSS CONTACT EMAIL: j rn g.1-Cd nt7sbrociAbc_nct. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: M.1J-k"-l'y, Contract Price of Work:$ <br /> Proposed Use of Building: g C CL.cf, Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units: ❑Commercial °Industrial <br /> Type of Project: ❑New DAddition ❑Remodel lit Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> CW <br /> ✓' Mfrt <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 /> NC-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 /> I 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•- rat bef., • .- . .. orized 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,.mply wiire State Cont-ctors Law 18.27 RCW and 296.200A WAG <br /> City of Everett Official Use Only <br /> PERMIT _1" <br /> 03/7.- OW 1(0 <br /> • er/Authorized Agent Signature Date (Revised 10/12/2015) <br />