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,..... X .(9 c 0 <br /> elPfrPERMIT APPLICATION - <br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> Nidwie 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 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: Pr/LA-5PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: u aI1k' kV1ojVt, .NANT BUSINESS NAME(Commercial): �^ <br /> OWNER MAILING ADDRESS: STREET V / �:r 1.- '/)Z Qtt4 Iv r , C't y' 'I g 3 <br /> CI ". j • '4, STATE ZIP 9` _'� <br /> OWNER PHONE: k/ 93/-ScOWNER EMAIL: ( 1 C(t/� 1 H 2-2 2 ai, 6144 r � r CcV-1 <br /> r' <br /> CONTRACTOR NAME: Sl'G l/l 5 /3(c4- /2/l,f 14 bf-t roo le V -. <br /> CONTRACTOR ADDRESS: STREET c" 1 17 <br /> 4'& J q J�/L <br /> CITY li-+q/l C.. r/'C,sri_ t rk. STATE t".../1„.4- ZIP 7S/S- - <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): r~(_ sEA_ ) ) n PO INRCICITY OF EVERETT BUSINESS LICENSE#(REQUIR ): -(MO3 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: (2.,‘4 <br /> Lvi\. CONTACT PHONE: 9c - --1-3 5-"9 <br /> f,..v, tCONTACT EMAIL: r..1an V!,v 2 22- 4'6)1440 re nrt <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ ,,/..A9b _ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New DAddition emodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 04 ' a t <br /> ,.t_•7 1 it <br /> f 1, <br /> f ' t S/tri- - i-ob/) d-- e,4/ 2 S/1if <br /> /c (-I � / 1 ( i / t <br /> ASSOCIATED BUILDING PERMIT#(i 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 aList 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 FountainSink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation 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/Insert/Log Roof Drains / Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: l-ic..eh t 1;3 <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 /> 14----- 7 <br /> �_..._ City of Everett Official Use Only <br /> PERMIT# <br /> /9 --deX17 p\,61 01,, n <br /> Owner/Authorized gen gnature Date (Revised 10/10/2018) <br />