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477 PERMIT APPLICATIO ', <br /> BUILDIN+!IVIIECHANICAL/PLUMBING /SIGh 'RINKLER/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:x ) ,9..? Iv-`- pave), 0LPROPERTY TAX#:,;r©P t 3 f1 l3 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:)( rC a rit LA-kit-55 TENANT NAME(If Commercial):/ 5 ,61: r`-cc, <br /> OWNER MAILING ADDRESS: STREETX 2/ �) /c7.4 Si- e •4 D 4../ <br /> CITY X Eilisilrt STATE,,{ �( ZIP)( L/// <br /> OWNER PHONE: fL-S'- a rj� 0 3 tic/ OWNER EMAIL: O©l5c-r\ ( v rylo- / <br /> CONTRACTOR NAME: r)64..)..4 i Jl '`� <br /> CONTRACTOR ADDRESS: STREET /Yt ,.- <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#{RE RED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: VOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,pG'R '?/3 - /2. 7/ <br /> /2J� 4///zCot CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION ' <br /> Existing Use ofBuitding: Contract Price of W .$ <br /> Proposed Use of Building: Heat Source: a: <br /> as El Electric CI Other <br /> Building Type: ❑SFR- ached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: mercial ❑Industrial <br /> Type of Project: Fie- <br /> ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �� r <br /> Ni\hi. obteA(JukkAic ok <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANJBAL PERMIT APPLICATION PLUMBING-PERMIT APPLICATION e <br /> Type ofProject: ✓New Addn._Alteration _Repair Type of Project: $/NewAddn 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 iWater Heater Other: G 4 s Pi pe <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> )Chemical or Water 1 INo.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.lam the owner,or 1 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 /> c <br /> I AA, 4, t_' _, I to 7 PER'Y Y l 11\O— OO2 <br /> • ner/A th•,�zed Agent Signature (Revised 9/23/2016) <br />