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MI= PERMIT APPLICATION <br /> Mil <br /> BUILDING/ MECHANICAL/PLUMBING /SIGN /SPRINKLER/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.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS 15° (j L(_. „c+-, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:67/ e'rvt•(,60z///Lt TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET /5201,JAL e_•-Si, <br /> OWNER PHON( 3 '71)-_7 O OWNER EMAIL:._. p0 iS. _ ..- , =i. <br /> CONTRACTOR NAME: et,f,rvi'/Z( mt•,)c I I r g 7, _ <br /> gc_ <br /> CONTRACTOR ADDRESS: STREET 2(Z() PA C L (✓ <br /> dry (Iv +-rSTATE /4,07 ZIP ‘,R7.0/ <br /> CONTRACTOR PHONE: frec- 2Z-- gi I t f CONTRACTOR EMAIL: u 2 b .(4) „5 Pl t.tom,.6-61,44, <br /> CONTRACTOR LICENSE#(REQUIRED): &V 502'2°'1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):007 el 67.c. <br /> PRIMARY CONTACT: ❑OWNER iilit CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (Lt -- 6!6-n722._ <br /> 4EN) (cfrie) CONTACT EMAIL: i4.e t�a 55 I44 loam (SO(A...- <br /> BUILDING INFORMATION <br /> trl> <br /> Existing Use of Building: Contract Price of Work:$ 5 5-erg 4. <br /> Proposed Use of Building: Heat Source: I(IGas DElectric DOther <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: XCommercial DAccessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: i <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(kltchen,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 I UA/1'r/1--X4-'7 . 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 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 lam 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 /> r 10 _is-- 1 /� / ( 00.7 <br /> Owner/Authorized Agent Signature Date (Revised 1'/10/2018) <br /> 0 <br />