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= PERMIT APPLICATI1
<br /> Nol
<br /> BUILDINENtIECHANICAL/ PLUMBING /SIGI m PRINKLER/ 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 B1acic Ink Only Pteese};:. ..,.. .. .PROJ CT;5 TE,INFORMATI" $ ,sf ..... ..... .... ..rili .. y.. .,_ ,,....,...,
<br />'k PROJECT SITE ADDRESS: 15�� Vit\'\M Y ) I PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> .. '.. * ,... COIITAC'T:1 NF ORMATI ON . }£ ,
<br /> 'tt OWNER NAME: r L\.\ve .g o l zio (ler- a TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET (5'.8 t tO LL0 pc- i) L. , ° C�p
<br /> pCITY C ,q IfetY` STATE (A Y\ ZIP L-( 2 9
<br /> OWNER PHONE: ()--5 5-0 t?'" ?1(5 OWNER EMAIL: S LS Y`` ( 4o.- -v e.�9&4,e7---
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<br /> f7d CONTRACTOR NAME: 4J -t?,'
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> -,CONTACT�- 'Fe_NAME: CONTACT PHONE: tee
<br /> -f 9 S O E" q -j. 15
<br /> ekt e-'(, .0 1 f .,'W t
<br /> 1 e,y 6 ` , CONTACT EMAIL: 'x(7 ( -s+o`-v`eN-c p cosimcco34,4
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<br /> BUIL©ANi���t�l`�>Fi;IVI�iTI©�I � � r
<br /> Existing Use of Building: Contract Price of Work:SAC. 2-06.
<br /> Proposed Use of Building: 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 ❑Repair ❑T.I. El Sign El Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> 6-Ar3 k' . 1 c Jb -K
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> gag MECF.HANiC4:=PERMIT;A!'P l I0TIOt+1 .E. ,= PLUl1 ll ll 4 PERMIT;AP "L'ICA7IOi*F..,.,v
<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 4.. Backflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range U11--r'etothes 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) y, 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 /> )C Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> SPRIINKLERI 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.lam 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
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<br /> 06 to o PERMIT \,40(,1,.. 0 5-(t,
<br /> Owner/Auth ized Agent Sign ture ate (Revised 4/15V/20119)
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