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(477- PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: &co 3 Z3 rd /Dr;a c- LAJ es 7 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: i. s J 9 i 4N TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (.0 g Zs .3 UJ 5 pt,r.1d bel-c,_ Sf <br /> CITY T C J a /"� 0 STATE n Z ZIP 9 7 Z 3 <br /> OWNER PHONE: OWNER EMAIL: / <br /> CONTRACTOR NAME: ,Pe/ �Di /YiRl' <br /> it, fi'l'e— fs'�J/eL)L%oWr <br /> CONTRACTOR ADDRESS: STREET /5-J Z Z j E z Y.07-''- ST vV� / <br /> CITY ge A/ 1 STATE ZIP ppq o %.2- <br /> CONTRACTOR PHONE: 3bO -9/I-6 6/cYg CONTRACTOR EMAIL: 114/7c ii S ® ,D-1—? Go,--- , (\ _ <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):C. ,„--; <br /> �._. (- • 1 �[, <br /> PRIMARY CONTACT: 0 OWNER "CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3 6,0 - 9/3 —O c7/8 f3 <br /> n1OVOi� ,5It-�'1� CONTACT EMAIL: pi;7c_h s ® f�_F/J, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: _ ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: l died(Lek 1,5,0(';,0�� /e r— -r -- a Gl'C/eC/ W x/45 <br /> act d Z- .50`r'';u 47„_ 0 4' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): v �e C%'-,�,�'�'.e 6/ C' /,'fv' r <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn /(Alteration _Repair Type of Project: New Addn _Alteration Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> - - — <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 /> — <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> --1 <br /> SPRINKLER/SUPPSION SYSTEM <br /> Chemical or Water 3 No.of Heads <br /> r <br /> ACKNOWLEDGEMENT:I have re re ed 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 lae_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,auhorized 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 ofofEverett Official Use Onlynl <br /> //4/ .74/ ,=-7'r/l'n/17 5//9 �� PER I�/#/y ( 7NO 0077 <br /> Agent Signature D e (Revised V23/2016) `l <br />