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477- PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES ''` M <br /> 3200 CEDAR STREET,EVERETT,WA 98201 • <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I ictiriii. r iiiikin <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:vg ( /1 i� ,n PROPERTY TAX#: (( � /�(y (. /^ /� _ <br /> LEGAL for new construction: Short Plat/su`bdiviis`ofi I ' Lot No. l) (attach` copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: j&1111 I — k / Park_ ,()(7r)Id�S---dyl TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET<(JC1 NAC07. 'Le, I I I ^/ <br /> CITY W V",----/-"" STATEW ZIP a� 3 <br /> OWNER PHONE:i,66 ----z--/G-610-� OWNER EMAIL:\\O I e,9 I-7 I rho() . ( (((2 <br /> CONTRACTOR NAME: ii .I FLam. <br /> CONTRACTOR ADDRESS: sTREE140011—J <br /> ir [tt,/(�O /�-7 2,72`m I/3 ,' 1, (��5 <br /> CITY 1 W✓' 4 J-1/I k �7/ Y i(r STATE ZIP�U( 1 <br /> CONTRACTOR PHONE: �1. b ---7-1 1 _---7 �) vl CONTRACTOR EMAIL: i�' " 17'/,� Mer�NNN17/ /�)n //J <br /> CONTRACTOR LICENSE#(REQUIRED): 13LUV Fl*35�a, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): J "� / ) <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) (57,/ 111 <br /> CO TACT NAM CONTACT PHONE: 1,(71.5--_4.`7— )- I t�Q <br /> nnY I \-i-ac,- I CONTACT EMAIL:j I lT U l����Up/r� �f 001-01,--,(20-47\ <br /> V BUILDING PERMIT APPLICATION /nI�� �/� <br /> Existing Use of Building: Contract Price of Work:$ `V i 000 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project:<iew ❑Addition DRemodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 7,6►llt <br /> duce p t 1) <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 #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units 1 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 /> Number 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 /> IA_ <br /> City of Everett Official Use Only <br /> / -Al I i C/ PERMI 10/12/2015) <br /> V O � 00 <br /> ner/Aut or'—�g- t re Date (Revised <br />