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Orerr PERMIT APPLICATION <br /> BUILDING / MECHANICAL/PLUMBING /SIGN /$OIINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: `03 i f~ / ! , kJ - jc_ , /1,4 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: `3 CALa;. TENANT BUSINESS NAME(Commercial): * <br /> mot <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: (2Ob) bi gig OWNER EMAIL: <br /> CONTRACTOR NAME: L.A-( t> (L,ta-/y)E' et <br /> CONTRACTOR ADDRESS: STREET / 69//:-. /* j,f. S ��`7 <br /> CITY f7(.,7-'/71/75-LC (A1/4STATE �� ZIP i ge,l - <br /> CONTRACTOR PHONE:( >74.4--,/ y!-P CONTRACTOR EMAIL: L4-13 pL Lam?/?,,� )C�.\'(-�/4 tL, C ,2 <br /> CONTRACTOR LICENSE#(REQUIRED): LA*1 p ~ ,t-•L/(•j /j ITY OF EVERETT BUSINESS <br /> �LICENSE Li <br /> PRIMARY CONTACT: ❑OWNER ....g1CONTRACTOR ❑OTHER(Please Specify) 1* (20\ 12./5 -I 3 <br /> CONTACT NAME: CONTACT PHONE:(2 o('„..) 3 h zii-3 O <br /> kt I./,/( Le/ CONTACT EMAIL: fc+4..4iJG7... e 6r/nt.",tL t ..0, <br /> f <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ li1 7 t c <br /> Proposed Use of Building: Heat Source: ❑Gas IElectric ❑Other <br /> l. <br /> use <br /> BUILDING USE: ❑SFR ❑Townho `I ❑Duplex DADU ❑Multi-Family-#Units: [Commercial DAccessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair .T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 13 11' 0)— V 13 <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, ces ,floor) <br /> c- ifl. � <br /> Clothes Dryer Heat Pump&Ductless Dishwasher C,,,,k.)) Sink-Residential(kitche ,batt),bar) <br /> Duct System(R el) Refrigeration Drinking Fountain f Sink-Utility,laundry, op <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain I 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 <br /> Chemical Suppression System INoNo..of 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 /> / L <br /> �– I //q PERM�Owner/Authorized Agent ignature (Revised 10/10/2018) LC <br />