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477 PERMIT APPLICATIO — 4,,,1(M <br /> BUILDINaECHANICAL/ PLUMBING /SIGN �RINKLER/ DEMOLIT101/4 <br /> CITY OF EVERETT PERMIT SERVIC <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECTSITE;'INFORMATION, <br /> PROJEC SITE ADDRESS: . PROPERTY TAX#: <br /> e /6 3-l- , Flo2 Eve +* u 9dZol 0os_9,357,1802.711, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION , <br /> OWNER NAME: The,tid s dp &orbas.ary TENANT NAME(If Commercial): ( /u tL.0 <br /> OWNER MAILING ADDRESS: STREET Zq/6 51-13-1-e '34-• <br /> / <br /> CITY /!�8^e� STATE Li p zip (23Z4 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ItOTHER(Please Specify) T f1 t(1+ <br /> CONTACT NAME: CONTACT PHONE: jo 6 9--6OS3 <br /> �I e." Q-f CONTACT EMAIL: ri cis ,A1-4iv1 Ary%E j'vetai b Cal--i <br /> BUILDING PERMIT APPLICATION ` <br /> Existing Use of Building: Contract Price of Work:0/0,000 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑;Electric • 0 Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: tkretivt�j Ex-I-traCircY1 gCYJv`'ly O "'Le S fc1/4- V7 ) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ` Q(O W ( r eza� <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 /> 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 lam 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 /> YilS/M PERMIT# ��1n0 j . <br /> Owner/Authorized Agent ign ure Datee (Revised 10/92/2095) /" <br />