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II II ''II 477" PERMIT APPLICATION II II IIII II <br /> BUILDIN i1MECHANICAL/PLUMBING/SIGN/&WFlINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: q I o g ' " '�k_, �j€ Eve„,01-A /i, �-ROPERTY TAX#:AtoczooOo 8 cOo ' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: i,iNt‘ ir\OtAIN•_ TENANT NAME(If Commercial): <br /> " OWNER MAILING ADDRESS: STREET y c / O e quA 1J I . s-E- <br /> CITY 1 All .Q STATE 'Ck ZIP °I, t7 <br /> OWNER PHONE: (2_'°6) vq- (,_(3 OWNER EMAIL: V`L(e\- 1`(. 00,Caouv. <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 CONTACTOWNER 0 CONTRACTOR 0 OTHER(Please Specify) 1 <br /> CONTACT NAME: rt T �0lt CONTACT PHONE: (2, <br /> 66) �qq— f/ow <br /> CONTACT EMAIL: / <br /> `f' e..J&o cow. <br /> . <br /> BUILDING PERMIT APPLICATION <br /> V <br /> Existing Use of Building: Contract Price of Work:$ 1 V5 <br /> 6-�000, <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial El Industrial <br /> Type of Project: ❑New ❑Addition jafiemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION// �` OFA`W_ORK: i p t[p,/�� /1 �y (y� o ff1) <br /> w W ki W I I 4 I y V 4/‘4,..C (&c✓.ate ISN e'C S. `iWo.Zi �(,i`l,.�YJW� w.r <br /> t ( 4 vv. . R, JL4. a�12-- - I' K i� r'-� ��. <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 /> A/C-Air Handling Units Heat Pump `3 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 I Shower Floor Drain <br /> Gas Fireplace Wood Stove I 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 UseOnly <br /> "` 1� PER <br /> MI <br /> `; I V V <br /> A 11 bog <br /> Owner/Authorized •gen'Signature Date (Revised 9/23/2016) <br /> ' '\241(.../ <br />