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�� �� ��CI `JOU' l='SS IM Wt'i1 Etre" <br /> 477. PERMIT APPLICATIOm <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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATIONn,�C — C - , <br /> PROJECT SITE ADDRESS: . II 40 34+ `f/ !� PROPERTY TAX#:6051-1./t0312)0i I <br /> & <br /> LEGAL for new construction: Short Plat/subdivision 71jS L <br /> J 1)^ ler Lot No. (attach copy of long legal description) C„[.0 vl61'•S <br /> CONTACT INFORMATION <br /> OWNER NAME: , Ot l(,. SIntefeir TENANT NAME(If Commercial): Vell'Vfv1 W[r{j?,l.SS <br /> OWNER MAILING ADDRESS: STREET 96 I�L)�� 3 eiSiV9� 4-ve, q L <br /> CITY it (/'t'� STATE VVI"/L ZIP l 6 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 4-4.47- --e -t5cc).- e_0 V [ v <br /> CONTRACTOR ADDRESS: STREET C 41, 3(( Ste. 3Z.-4- <br /> civ &OA STATE o4 ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: �/ <br /> CONTRACTOR LICENSE#(REQUIRED)SFQtSe(T 17"7 5.6 13 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 1.121:10 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR MOTHER(Please Specify) Crt�f nL ' ) .414)Vt' scr Veld'art ,jNj(Clt< <br /> CONTACT NAME: CONTACT PHONE: aoi, C`7a y32,4 <br /> 1M,a7"Vi�iz'5 CONTACT EMAIL: A V4 tz SD(v,Tkrs1 vi4'► .fi ri <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Wirth SS r (CCOy+rk. no ale Contract Price of Work:$ a© i 600 <br /> Proposed Use of Building: 6GU✓)1_ Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: fErCommercial ❑Industrial <br /> Type of Project: CI New ❑Addition t]Remodel CI Repair 151'r.i. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: t/tinier, W f fC 1A S S )71 .4-s Yy.04 t 44'1 Pixm-r i 1...»• G't j A Poill <br /> 11 <br /> Z4 -,ovl Rt201 pen' j fu 0/Asti It /04.1-,e4 f tis j 61‘4 & f'I2�5 r=M 6dei J <br /> (7h c. i c mF r&i h rcir~A.4-- f l�4- 4M >- pVLir. <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 /> 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 Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 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 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 /> 94, 5 ,1u-2-v1 PERMIT# ftiF� 0, <br /> Owner/Authorie Agent Signature Date (Revised 9/23/2016) <br />