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477 PERMIT APPLICATIC. <br /> BUILDIINu / 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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 34o20 D�,a?� ( TT X023 PROPERTY TAX#: 004 130 WZZO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:GEL-v-VL+a42 TENANT NAME(If Commercial): -' 7O <br /> OWNER MAILING ADDRESS: STREET 14-11 Z 1J5 9\ST ST <br /> CITY ��!✓ t�C) STATE WA ZIP 905 Z <br /> OWNER PHONE: f7j • 312 . �j(9k5 OWNER EMAIL: J\M 6�y—r 1�v ( CEl k�110(L i E� CST <br /> CONTRACTOR NAME: &(� j� t Cb HsTi2-U <br /> CONTRACTOR ADDRESS: STREET Qj( C�-7 T517OP LLW f <br /> CITY v STATE vv A <br /> ' 1 ZIP qg <br /> CONTRACTOR PHONE: 4(7.S355 - (CONTRACTOR EMAIL: SSCWC [t4.‘,2./ Cevv( 3uct <br /> ir .rz <br /> CONTRACTOR LICENSE#(REQUIRED): Ci pv' F 6.1L04�'-3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (2 I(c,O 4/ <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR OTHER(Please Specify) --k tT C—T <br /> CONTACT NAME: NA,L w t N1,41 ac CONTACT PHONE: <br /> q-2� • r 0(p <br /> T��� �JI2 l( 'TIG(l EETL �f1Gkh S CONTACT EMAIL: V-AA E�C �4,1=-Ctot[IGl2 CUt� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $_„ I, O O, rD <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: MCommercial ❑Industrial <br /> Type of Project: DNew DAddition DRemodel ❑Repair =iT.1. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: -I- 1rl--(Qi2AN "{ic,2 i-4E-IN <br /> tPtsC • W ol'Ltc 1 N U-ti OE co t,.- P_ucCt a N.L. c F^ <br /> NO14- Lo,o.fl t-16i I IST t.c2 V\46k-(1-7 ANzb fkv3 .ttec <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 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 No. 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.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 /> City of Everett Official Use Only <br /> PERMIT-1 — • <br /> ��- <br /> ('-2/1 ► 112. C) it <br /> O er/Authorized A nt Signature Date (Revised 9/23/2016) <br /> th <br />