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PERMIT APPLICATI
<br /> UILDING /MECHANIC,.L/PLUM -ING /SIGN /SPRINKLER/DEQ.°OLm•,N
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 J(E)everetteps@everettwa.gov J www.everettwa.gov/permits
<br /> )(Blase or Mack Ink Only Play i"ROJECT SIITE INF'I RMATION
<br /> PROJECT SITE ADDRESS: L 44 i PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 6,..t_r.,,,At• � o (A,A cf.. TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET . 0 P C.)y1IVA ( /�
<br /> i� !)\" tetc. CITY f' + _.�'l\ STATE 6r'-`, ��` ZIP 9i (j 6
<br /> OWNER PHONE:. i 1 t I OWNER EMAIL:bt-c�y- iwa.:'o
<br /> CONTRACTOR NAME L r i I ,e ca(4,1/4..'S / � Pc:,, I
<br /> CONTRACTOR ADDRESS: STREET 1P¢ 0 (o I~ d K(''' ( 7.::
<br /> CITY 5 STATE (Oen. ZIP g'2, 014c4
<br /> CONTRACTOR PHONE: 3 -7 9 j ..),,e) So CONTRACTOR EMAIL: R 3' o Fo (A.,V, t.t.A 6 ko L,a,C&L q
<br /> CONTRACTOR LICENSE#(REQUIRED): R 3 pif 14F flfr 0 4< ITY OF EVERETT BUSINESS LICENSE#(RE(;}CIIRED): to 56)%;9 6
<br /> PRIMARY CONTACT: 0 OWNER 05CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: E„i t).,5 Xit, 9 3 p[-t
<br /> ---- GO r I I i a,t, aj CONTACT EMAIL: Q J ��` � Y �
<br /> BUILDING INFORMATION 1
<br /> I
<br /> Existing Use of Building. ((`� 1,0‹
<br /> - ,,. "'act Price of Work:$ r) r 5&�j ' 9-`
<br /> Proposed Use of Building: I� (JX.. (� (Heat Source: OgGas ❑Electric ❑Other
<br /> BUILDING USE: @SFR ( Townhouse ]Duplex OADU @Multi-Family-#Units: @Commercial @Accessory Structure
<br /> Type of Project: @New DAddition DRemodel *Repair DT.I. @Sign @Sprinkler ❑Demolition @Change of Use
<br /> DESCRIPTION OF WORK:
<br /> re..pt ex .. eLt' .:re c7,Lord_()e GO0 , .111,-4:-;.i
<br /> 4 ` �
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): 6.,,_; U' C) e AR i",.AtiAtC43 ,
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture ' Fixture Fixture
<br /> Count List of Fixtures Count List
<br /> 'fixtures Count List of Fixtures Count List of Fixtures
<br /> A/C–Air Handling Units G,-: 'iiir} Backflow Preventer(Inside Bldg) 4, Shower,Tub,or Combo
<br /> Boiler -1aig� Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer j i' / C�eat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar)
<br /> Duct Syste• I) iRefrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fa:ORi. laed Commercial Ventilator Floor Drain a., Toilet
<br /> Exhaust Hood /.,:e I/' (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hyp Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhau,-'oodWside tial) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Fo.ed Air Systems Other: Medical Gas t 6 Water Valves or Fixtures
<br /> as Fireplace/Insert/Log Roof Drains Water Heater
<br /> "'SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other:
<br /> Chemical or Water No.of Heads
<br /> ACKNOWLEDGEMENT l 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
<br /> made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> 44PERMIT � ,�/1®d7l"D(
<br /> Owner/Au ized Agent Signature Da (Revised 10/10/2018)
<br /> lC.aa-0o ( al)
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