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4:-. ,r1 PERMIT APPLICATIOAi
<br /> ® BUILDiNC . zdIECHANICAL I PLUMBING I SIGN 'RINKLER/ DEMOLITION
<br /> E V E R lF 5 TCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> WASHINGTON (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) PRc JE T SITE INFORMATION ,
<br /> PROJECT SITE ADDRESS: / C§O i' 1 Ili ;j,-i aJ, V PROPERTY TAX#: v V ' 0 L I
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAP (2—•( 1TENANT BUSINESS NAMECommercial :
<br /> OWNER MAILING ADDRESS: STREET 10\fro 3 4� 1, , 0 �( �1L!
<br /> 22
<br /> CITY l�'\i�1Jv_��l STATEkr4 ZIP g <Y�l/%S
<br /> OWNER PHONE: i`' '3 cc—3 MO OWNER EMAIL: '1,1pf(_.,0j ( /Bow t u IAA
<br /> CONTRACTOR NAME: TO f ror-f�fj kc. - --rior1
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<br /> CONTRACTOR ADDRESS: STREET 92Zhi,9 (A,' A J i;10(,(,Fi-- -c---�itr-04-
<br /> 3
<br /> CITY r--r.AJ ! STATE N ZIP .6 c;
<br /> CONTRACTOR PHONE: 9.53 -,‘,...3)„- 5 $ .3. _CONTRACTOR EMAIL: a.,t.1scu ,yti'(>iL6 lFFi' il2il L J,_(,' i
<br /> CONTRACTOR LICENSE#(REQUIRE n: Yv `T 2.2.1,&36‘Q5 , Or ITY OF EVERETT BUSINESS LICENSE#(REQUIRED. SC,
<br /> PRIMARY CONTACT: El OWNER 15..CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ;S3 S3 _33 2_ 67%-2j
<br /> CONTACT EMAIL: f`rA pt St;p.-CLQ I --(0_,,,5ip 0. -�S rept-0,,i), !
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: -
<br /> } Contract Price of Work:$ '' . c,.
<br /> ,
<br /> Proposed Use of Building: Sc%AlVI , L,I
<br /> - _ vj i At
<br /> ) r Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel C Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: '{ �0100ia, wpc-cC P._ Nom„.„...,i, Do.. tt„r'za-'-Itv1) 1ti (,(, ive/A)
<br /> PirAu,u,.l T P 5i,L JA) ' I)P Vw'A 14,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture F„gum 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 /> SPRINKLER/ 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.I am the owner,ort am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the St to Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT,#
<br /> fol)pi ! V r
<br /> _—
<br /> Owner/.uthorized Agent Signature Date (Revised 4/15/2019
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