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477 PERMIT APPLICATION <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 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:go(e, ;cersmen i&k,7, e,_e_,-el-i- ',,f IS 9-1 ar:13 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 12CIN L©F II-Ives,i"G a TENANT NAME(If Commercial): (;cn I_ ©P fir-er,"cc <br /> OWNER MAILING ADDRESS: STREET 115( 1Vc2�1--I, Tr.I le,r <br /> CITY Ckrx l 5 1-e._ STATE V C__ ZIP 28 a S5 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (.lies Fr r r r L Cor c,'h—LAK- -i'ry rti <br /> CONTRACTOR ADDRESS: STREET 6(Oa. 0 c/-1.S-1-rte+ s,o*,i.t_ Li 0() <br /> crTY To STATE {fit ZIP 93 4406 <br /> CONTRACTOR PHONE: 253-�G y-yGa-0 CONTRACTOR EMAIL: `—Crcn (A,ece-ry-... t.cpr s)- Op, <br /> CONTRACTOR LICENSE#(REQUIRED): l.idt S frm.(' 1 p jl f)`3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER %CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �53 _, Li _9�..zd ) . <br /> 1 o, Grp f CONTACT EMAIL: �I^GI„�' 1 Si-Ir`,Gt`CCU/1S7-,co en <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: lar,_,(‘.teContract Price of Work:$ 5 o co <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ISZCommercial 0 Industrial <br /> Type of Project: ❑New ❑Additiontemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Tr.sEG I I rew be -k -Cor, <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 /> Chemical or Water I 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 /> PERMI 1 11_61, ) <br /> C >� 11 rt I ��--77 Y I v <br /> 6I 1 <br /> Owner/Aui sized Agent Signature Date (Revised 9/23/2016) <br /> 1 <br />