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mil PERMIT APPLICATIOlp
<br /> BUILDINJI.IIIECHANICAL/ PLUMBING/SIGN I' RINKLER/ DEMOLITION
<br /> EVERETTCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 l FAX 425-257-8857 l(E)everetteps@everettwa.gov l www.everettwa.gov/permits
<br /> (Blue,.iitW cjl InkiOnly Please).: . '....., ,PROJEC' SITE INFf RMATIOt r.m, > . .,... .,,.
<br /> PROJECT SITE ADDRESS: ---- .e:k l , bDkl\V(/a, e�� �1 ,IPROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision ST-E, a_ Lot No. (attach copy of long legal description)
<br /> = CO IT CT INFORMATION .
<br /> OWNER NAME: (y�'e C t(' j*' S TENANT BUSINESS NAME(Commercial):V kC,)"/\A----
<br /> OWNER MAILING ADDRESS: STREET 701 9— 5f S :
<br /> CITY _ EVA 't - S.�TATE V14,7 ZIP.47? a©g
<br /> OWNER PHONE: 4 2 oZ, -5113,_ OWNER EMAIL 5��"�C'�✓ r".,C� ' C"I '�:f-0
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<br /> CONTRACTOR NAME: SU ReAr--C'(� Cu SI-C7 A P1 U 1M C7 ( I-L- C
<br /> CONTRACTOR ADDRESS: II STREET `�
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<br /> \Qt-V ii6V 1 'I e, STATE ipfi } ZIP g a �/7d
<br /> CONTRACTOR PHONE: At a, .6 I a�4 (CONTRACTOR EMAIL: jJ V— I ore;,6t--D ,�I t,''j _° !ci A� `�
<br /> CONTRACTOR LICENSE#(REQUIRED): sop 4 , $. CITY OF EVERETT BUSINESS LICENSE#(RE 0 . -t`D)
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<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR =THER(Please Specify) ti
<br /> CONTACT NAME: CONTACT PHONE: 4� �' Ajt •,e5 j 09\5 441 r to t
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<br /> CONTACT EMAIL: 7t,-gem,3-77 ., Ca
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<br /> :BUS �'�. liilATl ,. �
<br /> Existing Use of Building: �/)i�anS Contract Price of Work:$ a 2 p1- c-V__,
<br /> Proposed Use of Building: NbJ�0,-\1Qc Heat Source: ❑Gas SIElectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ,,l£ommercial ❑Accessory Structure
<br /> Type of Project: ❑New Addition El Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition OChange of Use
<br /> DESCRIPTION OF WORK:
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> 0.0. AM1CAl.:PERMIT APPLICATION. .-01;0 1804 FERtinli A#►PLIBATION
<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(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'(S_ UPPRESSION SYSTEM„ Sewage Ejector or Sump Pump ( Other: p,A ;,
<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,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.
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<br /> City of Everett Official Use Only
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<br /> l/ l� PER yo\ `O ......
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<br /> Own Authorized Agent Signature Date (Revised 4/15/2019)
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