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4E77 PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov i www.everettwa.govlpermits <br /> SITE INFORMATION <br /> P O.IECTSITE ADDRESS: - - OPERTY TAX#: <br /> (a1r15 1120-;4:er DS-nrc rt!+t 1,34;c7 3- <br /> LEGAL for new construction: Short Platisubdivision_ Lot No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 10k if< C�U• tai TENANT NAME(If Commercial): � „�@ 55 <br /> OWNER MAILING ADDRESS: STREET I OC sr. Ie. (40-At ocej 1 -U <br /> CRY ri e, STATE Wit ZP f 3272 <br /> OWNER PHONE: (125)3 /3 5((o6 OWNER EMAIL: Ai16 )oivie j j rco(y <br /> i <br /> CONTRACTOR NAME: (1/1055 Yi?rcG�1, C„ <br /> CONTRACTOR ADDRESS: STREET /ZZZ' 54— -kw, SE <br /> cnY sTArEf z{ 20 <br /> CONTRACTOR PHONE: �C6)70-5�5'57 CONTRACTOR EMAIL: n1o55pe t Okfj.MO. ,CO/7-7 <br /> CONTRACTOR LiCENSE#(REQUIRED): Nt,O 55?FE 71' 'OO CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ?Oa/VIZ:fn. <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR %OTHER(Please Specify) nck—,C.e? I /ta- . <br /> CONTACT NAME: CONTACT PHONE: ) `'75'g-55 5 7 <br /> P eak ` 61 itek+- CONTACT EMAIL: eC (./ri,O$S—pe=t(-Z 1.cM <br /> T <br /> BUILDING:PERMIT APPLICATION <br /> Existing Use of Building: P t ,\4- 4-0g4,e 5 Contract Price of Work:$______24_000'`7' + +'t- <br /> Proposed Use of Building: H, C tzti•Oke, Heat Source: °Gas ❑Electric ©Other <br /> Building Type: °SFR-Detached °SFR- trached ❑Duplex JtMulti-Fatuity#of Units: EiCommercial ❑Industrial <br /> Type of Project: ONew °Addition °Remodel °Repair? CITJ, °Sign °Sprinkler tjDemolition °Change of Use <br /> DESCRIPTION OF WORK: <br /> --i-- 5va,llak;nn csF' act..., Nrop: hc�,-1 <br /> ntt�a.,ls (^ebur.re. ad siM. tes-1-ce!i-37,1,0 <br /> 3 ' t,,utes: btJIL.;A �k P, rid—/ 1-, Fiash',nfi}vr~ItebsM Jveede4 <br /> p-IL-$3,016+at=,,-veAir G{tw u.P re.n•t u ,'s fO,e ier G4eVis <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 xtures , of List of Fixtures #of List of Fixtures <br /> Fixtures f=ixtures ' rewires Fbdures <br /> NC—Air Handling Units t Pump Toilet Backflow Preventer ide Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas PipingBoiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater14, Refrigeration Shower Floor Drain <br /> Gas Fireplace . V Wood Stove Kitchen Sink&DisposalN it Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> - <br /> 7� s Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Se - Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> t <br /> 'Number of Heads <br /> ACKNOWLEDGEMENT:1 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 properly to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.2004 WAC. <br /> City of Everett Official Use Only C <br /> i '-- --- '''..°w7° .-742-/ )7-1,3'/ PER l Oq l <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> i/i rl <br />