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4rEir PERMIT APPLICATION
<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 3 2 O Co S k. c. A---c... -•e,E1 (d'Z,,, } PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: .JL;,co,1,4,‘..„ (3'ci^OAA 41-e TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 330 L., 1 kai^L A-4-c,
<br /> CITY Ck—Nrtot.ti' STATE ' A zip q & 2,--o,
<br /> OWNER PHONE: lic t`I —��t — 3 e OWNER EMAIL:JO IP a,1 e 1 Ip 11 co ye.L t L r,`, -
<br /> CONTRACTOR NAME: e K` • - S ery.,,,,_, .J
<br /> CONTRACTOR ADDRESS: STREET S fl 1 - ,,....(„r.�c_.(,- n,--
<br /> CITY K STATE LAA— ZIP q 62.,.0'7
<br /> CONTRACTOR PHONE: Lt 1 c,1,-)3 -l d t? CONTRACTOR EMAIL: w3Lt t\', IA c_N,A..i el.i- R3 psw c 1 t �-+
<br /> CONTRACTOR LICENSE#(REQUIRED)::�PACui'f (1�� j� ,f3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):✓ ,3
<br /> Li 7 L 0ElI�
<br /> PRIMARY CONTACT: OWNER x:ONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: L0_3-_2 7 3 ._t Oj a
<br /> J.A.s-his IA(Nit.A... CONTACT EMAIL:
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ 7,S 0 C.
<br /> Proposed Use of Building: Heat Source: EGas 0 Electric ❑Other
<br /> BUILDING USE: L75FR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition OChange of Use
<br /> DESCRIPTION OF WORK:
<br /> Um{e-"-kcg.(cc ;lik.rt�ilu c.-% .v'M rel.c,..-s(2" ,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<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 /> 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/ 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERM JT#��0q ' O� 0
<br /> Omer/ uthorized Agent Signature Date (Revised 10/10/2018)
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