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4ren' PERMIT APPLICATI II
<br /> BUILDINECHANICAL/ PLUMBING /SIG YPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only.Pleas.) PROJECT SITE INFORMATION '
<br /> PROJECT SITE ADDRESS: /1-1/1 ©aieeS a u-e- PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision 00 Lj so 4 -:q -o-soo Lot No. (attach copy of long legal description)
<br /> C. , ., T INFORMATION
<br /> OWNER NAME: //UE,2S, e .GC-fJEL L-- TENANT BUSINESS NAME(Commercial): '-"'
<br /> OWNER MAILING ADDRESS: STREET /t//I (,Qet- J' Q cue— / 92.a10/CITY IJ et c—1 STATE (i(,J,�' ZIP / 2 L O/
<br /> OWNER PHONE: gas= 2S'9- 0,S:'(,2 OWNER EMAIL: ,T'D 1-01--4-- Q.4) a P.` a A 01.7PI. ,--4-
<br /> CONTRACTOR NAME: W a..j A i n A re),-, t f/at= 6zit5 Fos /15 A-r-/,u 6--
<br /> CONTRACTOR ADDRESS: STREET ‘2‘ l S- S) S'i -Se
<br /> CITY /•' r u/ ere e j._ STATE 14„1/3 ZIP 99°/ Z
<br /> CONTRACTOR PHONE: L/2S-3 iii7 !4 i// CONTRACTOR EMAIL: /!v/CO, ,lrfflN,¢!"c.t RA-4_49QT Q9.42a1c,ca:4/
<br /> CONTRACTOR LICENSE#(REQUIRED): CC 444$/+/�t. -9/34.4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 044 ?P O
<br /> PRIMARY CONTACT: ..,_.. .. ,.0�. �. .��, . .. , _ .r,. r, ., �. ��. _,. .
<br /> OWNER .�. .
<br /> CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> 3 Sza�-35-s-131/
<br /> 61)atstwAl fir-) ,/v-,f-kms•L 6 k CONTACT EMAIL: 74 i r'u Tb.,. Zc49A._._ °eco
<br /> >,.`:.. BUILDING INr---° 4«
<br /> FORMATION`. /h o •4-#^ 1.0-4-G jcf-s, j, ,e; . Cc.�.,
<br /> Existing Use of Building: .5'/4i-7- /AL— Contract Price of Work:$ .�j $
<br /> 6 --na c'
<br /> Proposed Use of Building: "�S'/0 fluy'/4-` Heat Source: .Gas ElElectric ❑Other_
<br /> BUILDING USE: DifSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel f Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ieep/tt-ce F s, - cc
<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 /> 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 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 /> SPRINKLrE,R,I SUPPRESSION'SYSTEM Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System I 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 /> PE���S✓ t `O` )O
<br /> Owner/Authoriied Agent Signature Date (Revised 10/10/2018)
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