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PERMIT APPLICATION <br /> BUILDING ; MECHANICAL/ PLUMBING /SIGN RINKLER/ DEMOLITION <br /> EVERETTCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION ` <br /> PROJECT SITE ADDRESS: S i 1 S V V L-L_ ( J PROPERTY TAX#: �)(;' 43 7 26 7 to t✓i G'a <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C AWL(;120 irj CTOGV/US /VTTENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET�S (p 2 N-o <br /> S JTE �J <br /> CITY C.:- <br /> 1 L��l`—Yi!1 STATE ,N71%— /�, ZIP ciao3 <br /> OWNER PHONE: "6 _t �1 3 3 S�L OWNER EMAIL: G l j/) s7 _S-7Z kr/144ci j <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 14 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 LS -37 3 .- 3 5 Z C, <br /> • <br /> lA'V1,A 1,12-0.N To 1-1 lJ S I�^ILJ CONTACT EMAIL: ��l� S 7- 0✓� p Ii C t-met/l, CC/WI <br /> BUILDING INFORMATION <br /> Existing Use of Building: q (,') X Contract Price of Work:$ 1 c v C <br /> Proposed Use of Building: / C^' C Heat Source: ❑Gas H'Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: 4 ❑Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition ❑Remodel ErRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: _pc) ��N <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 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/SUPPRESSION SYSTEM 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 /> City of Everett Official Use Only <br /> PERMIT <br /> , i'vu W c..o(Q -00 2 _ <br /> Owner/Aute zed Agent Signature Date (Revised 4/15/2019) <br /> 1 <br />