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IIMPERMIT APPLICATI II
<br /> MI
<br /> BUILDIN� II TIIMECHANICAL I PLUMBING /SIG SPRINKLER/ DEMOLITION
<br /> EVERETT
<br /> CITY 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
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<br /> PROJECT SITE ADDRESS: t O({ 1\10-V,R,,.. ( n12/
<br /> PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> OWNER NAME: S.reti(42._ ('x)�r,v-\ TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET I t7 I f i\319-4-6-- PG„AJc.,'P✓
<br /> CITY . &3-(/✓e.--- 791- STATE t 4 J yGa- ZIP 9 g �
<br /> OWNER PHONE: .,Zff — -S-A 2 OWNER EMAIL: e_-c-, (A_o • L
<br /> CONTRACTOR NAME: 3 t°C
<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: LzlOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4_2_, ----2_,s--2_,- -c q 2
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<br /> CONTACT EMAIL: c;ve_L). _ ca t a,
<br /> , , ,. ,:. ., ,.,, . BUI UNG NPORMATIOW , ,. , , „
<br /> Existing Use of Building: Vie,
<br /> Contract Price of Work:$ 1 D( O t7'
<br /> Proposed Use of Building: t„„P„ — Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: LFR ❑Townhouse El Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑tleepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ir-e v"r v
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> .!gl,V,0110011141410,AVrERMIt APPLICATION: , PLUMBING PERMIT AP,PLICATION>a 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 Ventilation 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,I SUPPRESSI0SYS EM „, 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> \ City of Everett Official Use Only
<br /> // 7/7 � /)2 PERMIT# 0q() On
<br />• Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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