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PERMIT. APPLICATION <br /> 4477 BUILDING / MECHANICAL I 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 1 www.everettwa.gov/permits <br /> (Blue'or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:2y/f//k$Y i'vcire4 G/A, fe yo/ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: fonon Got Edl4t-TC t(wko TENANT NAME(If Commercial) 04/ 4..r 4 . <br /> OWNER MAILING ADDRESS: STREET 2'Is'f/f ,s'T <br /> CITY 6/OffA0 , STATE 4/41, ZIP 41°1Q/ <br /> OWNER PHONE:6/20 2.f2",j 4,(54 OWNER EMAIL:6k11l1,K*4'*' KQ 1ONMy cove4ppv► <br /> CONTRACTOR NAME: ,f'f '5f <br /> CONTRACTOR ADDRESS: STREET /7f-4 Avg Rol dcd xrr /o/ <br /> CITY P/t,(/•T7 L STATE z//¢ ZIP WOV7 <br /> CONTRACTOR PHONE: (o J '/ j 3s'j'G CONTRACTOR EMAIL:uz.y ®a.f S. 60 Ai <br /> CONTRACTOR LICENSE#(REQUIRED): Kgscoltiel4 007 es?7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):a$.3""4/ <br /> PRIMARY CONTACT: 0 OWNER 000NTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:1/47;tin ? cf� CONTACT PHONE: (z4) v <br /> CONTACT EMAIL: L%ZY�,k ar.f cervi <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: lifraehrtosufj Contract Price of Work:$ 33 <br /> Proposed Use of Building: 4m ~447 Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ,IMulti-Family-#of Units: , Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ,€Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:oise R�l lose( r2 PifrC ..f ?04 ,,.fJ c�f,lw,clC josoi,t-ix) <br /> Aper roach� -/Ndht el M,r� Sri ii givi�iJ gn -Gs�r,�R Atr4 Yr tot4# (pip lel IA 1-10 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 6/70%—oz <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn _Alteration _Repair Type of Project: _New _Addn Alteration X Repair <br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump (p Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 4 Bathtub Urinal <br /> Gas Piping Boiler (, Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove (p Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood 6. 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 •to C. ra tors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / PERMIT# f <br /> Owner/A hod e, Ag7 t:rgnature Date (Revised 9/23/2016) <br />