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477PERMIT 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 I www.everettwa.gov/permits <br /> x. , '_ . ..P_ROJE_CT�SITEINFORMATI.ON . <br /> PRR,a f fir_ l�__ _I��_ JO r�y / a J 01 PROPERTY TAX#:oct.r, 4, et 00 9_0( 6 a U <br /> LEGAL(Ofor new construction: Short vPlat//subdivision 171111P y1U)S"1 '9I J Pt Lot No`6""i ffta t�opy"of long legal description) <br /> :: CONTACT INFORMATION> _. .. <br /> OWNER NAME: �C,k.rA1 to Co82.v\el- 13Q{L,yy� g)TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET l�Ors- fa C62._iia. ?1 <br /> ciTY k i \ Y,8_ C-JA STATE ZIP 9 o 4L <br /> OWNER PHONE: OWNER EMAIL: IOW[GLA)41C��t� ��l . LO"I 1 <br /> CONTRACTOR NAME: ., i do C��viV— la)Q.-F-omov'(-t <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: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: _ CONTACT PHONE: A6 9 6Z(q <br /> � �+Ia) lf2.V� b. 'GVtO---I CONTACT EMAIL: <br /> ,:. BUILDING,PERMIT,kAPPLIGATLON. <br /> Existing Use of Building: Alrat--6..pS t DU?to K. Contract Price of Work:$ 2.0, 000 <br /> Proposed Use of Building: Heat Source: ❑Gas Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached Kuplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign •❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: C ` oNl--Acoj .t-t› a c,✓trtddS <br /> lacesot-t e, aka 3w�-k=-�'l 14t.nr�CT S e Ki.o✓L. �oo�+'r, p(cc,..f e�y <br /> ASSOCIATED BUILDING PERMIT#(if applicable): t 14..✓L f d o .//,,��C (Jd s �'/ l+k <br /> MECHANICAL'PERMIT,APPLICATION ;., : .,,, PLUMBING:PERMIT.APP_,. T:!Irloptimouggem <br /> Type of Project: New_ Addn Alteration Repair Type of Project: New A.• Alteration Repair 1 <br /> 1 <br /> #of #of #of #of 1 <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 12,„ Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 2, Bathtu• Urinal <br /> Gas Piping Boiler v 7 L. -.ory(Wash Ba-' Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain j <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap i <br /> Gas Range Ducting I Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas t <br /> Range Hood Water Heater O r: 1 <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Othe. 1 <br /> z ;SPRINKLER;I SUPPRESSION SYSTEM:::, <br /> Number of He.:s <br /> ACKNOWLEDGEMENT::I have reviewed t is ..iication 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.Ther=nh a •f 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 *er a `ircumstance.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 1 comply with the State Contractors L l CW and 296.200A WAC. <br /> i+7 City of Everett Official Use Only <br /> � PERMIT# <br /> It <br /> a)IIT V ZFI I _ <br /> Owner/Authorized Agent Signature ate •� (Revised 10/12/2015) <br /> g 9 6Wnoq^D.01 0 1 <br /> w 1 ,/J 1 <br />