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!iir PERMIT APPLICATIOI II 0
<br /> BUILDING ECHANICAL/ PLUMBING /SIGNMJ''SSI RINKLER/ DEMOLITION
<br /> EVERETT
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue er Black Ink Only Please],;r,,,_,, ,,s . PROJECT'SITE,INFORMA'TIOl�#. ,
<br /> PROJECT SITE ADDRESS: e��j G 4'(.e PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ... .. ...-,., a..CONTACTJMFORMATION . ..,. ,- ,. .-
<br /> OWNER NAME: i)0 1 VVI t" 3 ! yvx GvL0,_ TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET ?f 25 0- C.--1WL) 4-G"_e_ 9
<br /> CITY '(� /�Q STATE 4. G. ZIP er2e`,
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET i 0 7�J?j 1 F La-e_e_. VAC. /
<br /> CITY / ` "ICkfl_ STATE Vit._ t�, __ ,^, _ ZIP 9g2:-7
<br /> CONTRACTOR PHONE: 9-2' cm 3-.s-3 53 CONTRACTOR EMAIL: d.e ru(s 1- i 1 .a.a- Co)I1(
<br /> CONTRACTOR LICENSE#(REQUIRED): / EL r2, E-5 5s O h CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): `7�pZgIS
<br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4_15 Z_ 4 d / Q 7
<br /> 11 'II r c,J 0 YV1 lih CONTACT EMAIL:
<br /> Existing Use of Building: ,13'-r -Q ' Contract Price of Work:$ 6`51" 075
<br /> Proposed Use of B�jlding: 5@ .'-"-e Heat Source: I6as 0 Electric CI Other
<br /> BUILDING USE: CISFR ❑Townhouse 0 Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition f .model ❑Repair ❑T.I. ❑Sign ❑Sprinkler CI Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: _
<br /> 7 .74- _f2)%1-4)-c--e--c. ,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): ,
<br /> ..,;, ME 101IG* 1010#T A0140.,A,T,IQN -. ..-.. <, P
<br /> ., PLUMBI#0*ERI1f1lT APRLr!CATXON' ,.:
<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 Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-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 I SUPPRESSION SYSTEM-.; r' 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> „--------7----------r- T/?/ 2C)/ y 04(9-0 -02-1
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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