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477 PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN I 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 I www.everettwa.gov/permits <br /> P._.ROJECSIT <br /> T E;iNFORMATION „u <br /> PROJECT SIT DRESS:v z7 e f e ,7 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />• . , 4....,> ' :C NTACT:INFORMATiON s.„ <br /> OWNER NAME: f-yeV(/()•e 0/z nA TENANT NAME(If Commercial): 0U'14 R <br /> OWNER MAILING ADDRESS: STREET f• ifd}/�- i ',11 f. r i/ :A.,l.-% 7i 0 e 1) Slak /01 <br /> /� <br /> crrY .NI ecn6hr/ <br /> o , STATE A .ZIP 491J <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: I "`F,12t-....._ . SUTT 1q M - y/T" - 13 <br /> CONTRACTOR ADDRESS: STREET ZOta AVE 67 <br /> CITY S N blh 4416(j STATE ✓V A— ZIP /7 GJG� 0 <br /> CONTRACTOR PHONE: (3100) 3j 0-IO/l� CONTRACTOR EMAIL: 41 Su 7 ' �'eo#ic6 - /,(16-_,t <br /> IC <br /> CONTRACTOR LICENSE#(REQUIRED): 9CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> _ ._ . �tR-v�- Tomf3 7.� VTT <br /> .._ <br /> j <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR MtU.OTHER(Please Specify) d t ea.( �1rS eIu4keg <br /> CONTACT NAME: lu.Alt I, �•'�'t a CONTACT PHONE: 3604 8 I./9_ o/ zv <br /> E- <br /> CONTACT EMAIL: Nl sv`t/,u 6e_c.,nil ti4s7 ,A/c- <br /> ,.. E $: ' . , thInz NG.:PERMIT APPLICATION.., . ' : ,. ': ., . ... : <br /> omeim <br /> Existing Use of Building: Contract Price of Work:$ 00 <br /> Proposed Use of Building:Op:TOO 0/`FI(iE-- Heat Source: ❑Gas ❑Electric <br /> / DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: I�rc;ommerciai El Industrial <br /> Type of Project:Flew ❑Addition DRemodel ❑ 1Repair r.I. ❑Sign ❑Sprinkler ❑Demolition 'Change of Use <br /> DESCRIPTION OF WORK: <br /> wi ed t c , /v, 'v- 1 e v&f . Pene(--6(e., <br /> q — )e. ( A-14(TIDMie- q De,41 vAaakoli <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ` MECHANICAOERMiT,,APPLICATION „ ; Wet _ .;;'PLUMBING`y ERMT APP,.LIGATION ,3 _ ,_. <br /> Type of Project: New_ Addn Alteration ^Repair Type of Project: New Addn Alteration Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures d <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet .Backflow Preventer(Insde Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal I <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 I <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas X <br /> Range Hood Water Heater Other: e AL ft� <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: ' Jlesr-/ti I UM:- <br /> AtiSPRINKLER/S,V RESS ON',SYSTI:M=` <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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �1 ', <br /> PERMIT# <br /> �Ilaalk �4 -a3-- -, a P( 7 • --003 <br /> •wner/Authorized Agent Signature Date (Revised 10/12/2015) <br />