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_ PERMIT.APP1LUCATIIO <br /> } <br /> BUILDING I MECHANICAL I PLUMBING I SIGN J R]NKLiEiR I DEMOLITION <br /> 4 ' a�= CITY OF EVERETT PERMIT SERVICES <br /> . 'may 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 /> (ISDape'o r Er.back Dank Orally Pllease) PROJECT SITE ONFOGRMATIIOINI <br /> PROJECT SITE ADDRESS: 7 53® Cello/ Ave. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT ONIFORMAT DOG`S <br /> OWNER NAME: 60‘00P1 / 6Gii e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET i 1 foie <br /> CITY Vvereft _ STATE WA- zip f o <br /> 00 i <br /> OWNER PHONE: OWNER EMAiL: <br /> • <br /> CONTRACTOR NAME: J( r.H 11€. <br /> CONTRACTOR ADDRESS: STREET <br /> ICRY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSK S LICENSE <br /> #(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR -OTHER(Please Specify) ArfiCt.%'/C, , 61,1 ,a <br /> CONTACT NAME: (ter�- CONTACT PHONE: 746, `o2_, 5j 56 1 <br /> 4 re-62 6 CONTACT EMAiL: 4.9 t'e.-e4C p,10 • ' 4 ..._ <br /> %MOH'.0 PE'r IT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$_ <br /> Proposed Use of Building: • Heat Source: ❑Gas ❑Electric ❑O{her <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: CI Commercial ❑Industrial I <br /> Type of Project: ❑New DAdditioon ❑Remodel El Repair ❑TI. ❑Sign ❑Spriinkler <br /> ❑Demolition 0Change of Use <br /> DESCRIPTION OF WORK: tOi /$ f mo / Ac Sfi, igkP r r5• <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> T MECHIAI DOAL PErMIT APPLICATION PLUMl3II OG PE 1'MIT APPLOOATOEI <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 /> 1 <br /> SPRINKLER i SUPPfzESSO©lN SYSTEM <br /> Chemical or Water No.of Heads <br /> ACIWOWLEDGEMENT: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 Law 18.27 ROW and 296.200A WAC. <br /> l, j;/ - - City of Everett Official Use Only <br /> I' 17(P lePERMIT4.'p (so , - tcy <br /> Owner/A�i"-� = L gent Signature ' ;pe (Revised 9/23/2015) <br />