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PERMIT APPLICATIC .
<br /> BUILDII1I I MECHANICAL/ PLUMBING /SIGPRINKLER/ DEMOLITION
<br /> Z"III -4CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> At�'�
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov ppomerLscrettwa.gpePPhits
<br /> (Blue or lack Ink oshePleased:_. .. PROJECT SITE INIFO MAllOt ,, . ..,;
<br /> PROJECT SITE ADDRESS: at 001 S c Evev(k- ,•ICA &,t(ICP OR PERTY TAX#:
<br /> S ,
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> 11. .% -ONTACT INFORMATION ;,
<br /> OWNER NAME: 3 v\-1�co 't(v\ow\Cik e\M e/*•TENANT BUSINESS NAME(Commercial): )IJ A\V \-\-t. C 1ck€p
<br /> OWNER MAILING ADDRESS: STREET `Z 0 t 0 • 156'' kievt JL IU E
<br /> CITY x'L\\e..„\LU U . STATE WANZIP GI(60©
<br /> OWNER PHONE: y?.j LA S•- I i 5 a OWNER EMAIL: VCAJC`C\Ck–Ice su pv - C 0, c,dvieN
<br /> CONTRACTOR NAME: C(LL7 SS iro0•0 hSnv.
<br /> CONTRACTOR ADDRESS: STREET f1 �4 -lk\ 0 L Wl
<br /> •
<br /> CITY L�N I"1-4.0 AVO STATE L- ZIP &03-9-
<br /> CONTRACTOR PHONE: (c'Z 1 `i V\—'~!1k\\ CONTRACTOR EMAIL: e`VN,rd\(j)ew kertp (,,-j ,„. _.:_•••r-!,.., 4 ._
<br /> CONTRACTOR LICENSE#(REQUIRED) �It G Sc S-�E IA W\ ‘..._ CITY OF EVERETT BUSINESS LICENSE#(REQ i'9)! 'Y"Np
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) _' ' / _ w�:+_I. A i
<br /> CONTACT NAME: C \S 00(r1 CONTACT PHONE: /5_,:`," C E.{ZS) 4 v i— 4 `I �` 1
<br /> CONTACT EMAIL: e v'l C V\Yt S ,,,wa,1ez. -�,,.Y1 ckA s tc-I V, ,C',fi
<br /> ki::',.'m%:1,..g.., :, ,,-5•1,,,y,,t3R-.:: ::::z.:, ,v:7tErw:F:::,,:;:m.:igvow.pm. :::;J;RAtottkitiOitNrOitsitAtiolif-'i:',I,4-:-,;:oe,--:- ..:::04.i:04*0,;;-: ,q.,:m.:4A.;-9Eviimyiii,m§n
<br /> Existing Use of Building: Contract Price of Work:& i ,Ply•
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Ele •—'r
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex LIADU ❑Multi-Family-#Units: ❑Commercial OAccessory Structure
<br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: \h ```��� la'X V I t�v I/20)C 0 Yl .,0--A.,14 l e � U.)-7A \
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ME.CIHIANIt Al PERMIT APPUCA`TtON PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/InserULog Roof Drains Water Heater
<br /> SPRINKLER!SUPPRESSION SYSTEM, Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System 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.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 /> 1 City of Everett
<br /> tOOfficial/Use
<br /> �Only
<br /> r�
<br /> C I !,1 PE ,C D—\ --'00(Owner/Author2,1.---'5,.--
<br /> ent Sie I Date Revised /10/2018) 4311
<br /> 1r9
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