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PERMIT APPLICATION <br /> „qvBUILDING/ MECHANICAL I PLUMBING I SIGN /SPRINKLER/DEMOLITION <br /> miiw�-- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink;Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:'/,9.,. A/ AreQ/1*Jc -4-J) PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: / i / /.62ven TENANT BUSINESS NAME(Commercial): 01 � I y' <br /> OWNER MAILING ADDRESS: STREET re ' dt " k <br /> - <br /> CIN /1/0 i. ,1T�0 STATE s 4 ZIP . <br /> OWNER PHONE: c�- '-- -3 - , T OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: ;STREET r9 �D ee/6 / 212 <br /> CITY //a� �J,,65? STATE /1„..., ,/9 ZIP <br /> CONTRACTOR PHONE:44-3.- :7 — .' Z _3 CONTRACTOR EMAIL; 'iciy.� J c z v &&77. ,,, ,7 C7,044.1 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:, ' --- q ---�J�✓�' <br /> /v 7/: sl3teeC,C__ CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: CI Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition El Change of Use <br /> DESCRIPTION nF WORK: <br /> ebit/t0Wr&lal Ar i /5) t/f?f,e2 6Y 41 r0ivr/ 1teie,taFc..T' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): A4",16 '-14H�'Sff3--eo>xp s 2CD�x, 5,)?A S s h awe sot IG <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 /> A/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) / Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer J 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/Insert/Log Roof Drains Water Heater <br /> SPRINKLER i 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.f 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 /> ,,,P - " -/--4/ Q -dig1 ciD,— 0 <br /> 03 <br /> Owner/Authori d A.ent Signature Date (Revised 10/10/2018) <br /> e_OU4-041-A4F44 <br /> to( s(o'i —b y,, <br />