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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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Li 5%CI 33 t a Avenge 1 4s* PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: * DVlPa5cittat TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET ilg'q ,3rx( Avenue WQ 4- <br /> CITY r �yr( -e, STATE W.K ZIP -{9 3 <br /> OWNER PHONE: 34:;.0- }(tsd 35ci OWNER EMAIL: <br /> CONTRACTOR NAME: "le. ?kuvnio t 11L! ct1V tWct i pemv <br /> CONTRACTOR ADDRESS: STREET <br /> �[Z(p4es"4- <br /> CITY c {cA CCS A STATE Ihr J ZIP <4)4145 <br /> CONTRACTOR PHONE: Sl - 44O- 143 CONTRACTOR EMAIL: Set' ce WQ P dco. corn <br /> CONTRACTOR LICENSE#(REQUIRED): PL UIVitVC.teq I F CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR OTHER(Please Specify)fa-Fr►mak- re.A\oUM\ +Cal 353"7 O.7 q <br /> CONTACT NAME: i CONTACT PHONE: 353-7 a b 94 <br /> Fe ro . I�Ec I\ma CONTACT EMAIL: p rick.& w4pcko,c.e('1 <br /> BUILDING INFORMATION <br /> Existing Use of Building: 3,e�e Contract Price of Work:$ 625‘19- <br /> Proposed Use of Building: Heat Source: 14Gas €lectric ©Other <br /> BUILDING USE: I .SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: OCommercial ❑Accessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel DlIRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> eepkce 1-ot.tnd wct.4er sump pave P r R \ace. -sump puyv p for kkAiNctry (Sefer4e). <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION 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 /> NC—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 0,+" Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation ...( Floor Drain .3_. 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/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/`:SUPPRESSION SYSTEM a,. Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 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 /> V & oi <br /> City of Everett Official Use Only <br /> PERMIT D <br /> Y./QOwner/Authorized Agent Signature ate (Revised 10/10/2018) <br />