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PERMIT APPLICATIO��
<br /> #11111LAII°.-
<br /> BUILDIN&1..I MECHANICAL/ PLUMBING /SIGH RINKLER/ DEMOLITION
<br /> �'�'�' CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue k nr O 111i,.Piease m Ix PROJE04,10Ij: x , ,T(ON=... .
<br /> PROJECT SITE ADDRESS: Lp pb2j((,i ,Gun t.UQ..) PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> a��` ., � �yI i ai I i l( i i�n ., ,�tl ik
<br /> _ uiNY .3 n it II 4'+ir.i.t
<br /> OWNER NAME: cd..e,(A.Q. t'lszym TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET IS( - N.A.eiCt C to owL.
<br /> CITY (,N RSTATE NA zip q,R 20 Q
<br /> OWNER PHONE: I-2S- 5:>:.1 ' 099--( OWNER EMAIL:
<br /> CONTRACTOR NAME: i) --cl„�c?x\ fk-e 't1 &..41.0k1IINY>,,e, CA`/VY' �o( 1 0 ns
<br /> CONTRACTOR ADDRESS: STREET e b 60,4 1t g
<br /> CITY I4A.g.1/ VIS( STATE v7l ZIP CI g2
<br /> CONTRACTOR PHONE: `32() .i p g _eielf CONTRACTOR EMAIL: j t"\'r(.) `0.) fe „e \f) �° i.4 COp�
<br /> CONTRACTOR LICENSE#(REQUIRED): f f-k c 6,{-FC g l Q2 1-A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):( Q J p
<br /> PRIMARY CONTACT: ❑OWNER I CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: '?Jt.to() . 1..P -- , 1600
<br /> `i,�, S fl I\�� CONTACT EMAIL: ')y ') f'�&b v� dVL , C�YY�
<br /> ` ��_ s = BUILDING IF FORMATION I` �lr_ �j5.
<br /> Existing Use of Building: Contract Price of Work:$ ' )--O )s U-
<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 fgRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ;'=. 4 NI MNICAL-PERMIT APPLI4ATION, . . " 'LUMBING PERMIT APPLi'CATIO 1; =
<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 1 Water Heater
<br /> :::tilt.-7::;:117,00:,0, tSUPPRS;ESS .SY TEM ',' Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System I 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 /> an• omply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> 4
<br /> City of Everett Official Use Only
<br /> .._ ____ t.'L_______
<br /> PERMITn M._
<br /> Owner authorized gent ignature Date (Revised 10/10/2018)
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