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477- PERMIT APPLICATION <br /> BUILDING 1--- HANICAL/ PLUMBING /SIGN / ; INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 11-12-13 ( /k i4V.SEPROPERTY TAX#: Zt3i`s j Doo gob tor-, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> L CONTACT INFORMATION <br /> OWNER NAME: IA/,.1S``Un Le SS I x TENANT NAME(If Commercial): PR, lyt 4'zi'= S <br /> OWNER MAILING ADDRESS: STREET 11`0S 11 11'11/ AVe S S t-t (� L C� c <br /> CIT' L�/C�✓'e.' STATE �'1 ZIP <br /> OWNER PHONE: t <br /> crn•> l^ 2�j�trfi OWNER EMAIL: t� n 5•f 7 j ( /L / 19t iu,•( . L-Git <br /> CONTRACTOR NAME: L.4 1 fed S•j J 'k.w S t e.t h u t La t f c- <br /> CONTRACTOR ADDRESS: STREET (11:y a /9117J0 wa� J U t 1') J:1-e.. 2o1.. <br /> cnv • -Ca f(t. ' STATE IAr tfir ZIP , /3"1 <br /> CONTRACTOR PHONE: (ZQ6) CONTRACTOR EMAIL: f a ivi'D +4j_- vYj e C11 to i c.t I, cu;Al <br /> CONTRACTOR LICENSE#(REQUIRED): LA/ IT SO4 (f6 2.. Oil CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 05.`I LI 1 6 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: .1-7,)1-4 )2 i' J[j j CONTACT PHONE: @OC) ‘/(01-it- J 7/( <br /> J CONTACT EMAIL: d u S•_ ,may,e.AI(.4e1 i , <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ ( ', 7 2-S-, <br /> Proposed Use of Building: IDer1 f S f' Heat Source: ❑Gas CitElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: EX ct ctkL(- dis't<ri,t noel c-2) csX IS f•0'v f sr I r { .i`7 eti f pw't <br /> pj <br /> c t add/v t('a ct{,c 54/Pix c rpm. ' "1 9nile✓ k r ii c ie F c- (7) lte w t ;stet. 4.n d <br /> ctuc.')'i►^o - t� i- Cvles11 4..1`f a'd tFl,ctKS f 4c mei 541 6 t-,54+ Vc"ll1^ff -(Z) C/v./lief r'V <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 #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-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 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 /> ? „ / /` PERMIT �0 i /O <br /> u <br /> Owner/Authorized Agent Signature /If <br /> ( (Revised 9/23/2016) r i <br />