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PERMIT APPLICATIOt
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<br /> BUILD Nu I MECH '1,1 C/A.L 0 PLUM ,ING I SIGN-1-SPRINKLER/ DEMOLITION
<br /> EVERET TCITY 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) PROJE T SITE INFORMATION
<br /> PROJECT SITE ADDRESS: ti're �- (, vQPROPERTY TAX#: ttl,3 CY'S -.G`tt '...-S '2Y��
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> • CONTACT INFORMATION
<br /> OWNER NAME: �iy,;� : C�..)� klf TENANT BUSINESS NAME(Commercial): ,
<br /> OWNER MAILING ADDRESS: STREET \` \i� 6k1 0
<br /> k_.. � �"CITY ) r STATE CZI I
<br /> OWNER PHONE: Lk +' S 'CZ,
<br /> �(J1'G OWNER EMAIL: . N N\J il fa-. .� - -Iati`J - `l `I" f
<br /> `
<br /> CONTRACTOR NAME: c-. ..-0.
<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 ❑ CONTRACTOR ❑ OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ly`✓�\\ '_2_4 '.` ' -- i'm' i ,
<br /> 4- --{,( OA�1 4 CONTACT EMAIL:
<br /> I BUILDING INFORMATION
<br /> Existing Use of Building: 'e' �
<br /> - �\• Contract Price of Work: $ .'C:_,
<br /> '.._- --
<br /> •
<br /> Proposed Use of Building: '',"; :\r\,;. Heat Source: tlbas 324Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ��/❑''Duplex ❑ADU ❑Multi-Family-# Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition i.dRemodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ())6/
<br /> t,-L-----,,_ -*--- , ""��
<br /> ux,--r-,.),LL _,,k),kp. :,.siA 1---,, -0,-, IF,,L.,, ,,.-fts --v, vkq,__4Q__ 4,z) 6: ,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable : „i �--- '”- a"' �" a ik( � �f 6,M,
<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,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, or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and I compl with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PT)IT\tlCA. 0 i '.k IRIV , II ` ........02......__
<br /> Owner/Authoriz:. •_ent Signature to (Revised 4/15/2019)
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