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0477 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 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: ';23 (1)a,n:k ,`jr PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): L„,„,.. N tit i Lo.,..,,,,,vie__ <br /> OWNER MAILING ADDRESS: STREET l <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: .[f4.4 fry);14 ;60‹ rA , 4 04. <br /> CONTRACTOR ADDRESS: STREET jp,7 xfc _2ji, f1-7 6i. <br /> CITY VR/. W,60rA STATE .� ZIP q�CI5� <br /> CONTRACTOR PHONE: t-fa,5 SO/;, -17-7 33 CONTRACTOR EMAIL: ,Cl ujfi1t 'P (1q LjU� .C_ .'I't <br /> CONTRACTOR LICENSE#(REQUIRED): L(,,,Mri 7,3,CU CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):$.4 <br /> Cktl 5 <br /> PRIMARY CONTACT: ❑OWNER C9.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: rte-} .6\-c,;c Contract Price of Work: $k_. ;,-( <br /> Proposed Use of Building: r V G: J ScLI C 11 Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: rOCommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. I:3 Sign CI Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> r1'YisAc t I-- S et- i_ 17 is I i aivt;enc- k- i iK=( 1ef/e''' 6)4 <br /> Re(cew(11 <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 /> A/C-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 I 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 State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> j - 7 PER # <br /> r = <br /> IerlALtSorized Agent Signature Date (Revised 9/23/2016) <br />