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� PERMIT APPLICATION-
<br /> BUILDINCHANICAL I PLUMBING/SIGN mRINKLER/ DEMOLITION '''
<br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES
<br /> • 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> Bluecor B aok Ink Onl ` Please PROJECT SITE INFO AT 3
<br /> PROJECT SITE ADDRESS: 75 2 3 U(/�t:.a,-- j Q"9z 20/ PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> .:; _: - ,,. .. GONT;ACT INFOR04ATIOiV„
<br /> OWNER NAME: C" 5 a-c,tL 01--- .OGI of 4L / TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET I Z 0 'It lit" I .i 5+— Sj-/G 6,1• S„ f.. 1-e.. —
<br /> CITY e-,v 4-)< STATE L''''/4"-- ZIP el t- 1 77
<br /> OWNER PHONE: Z 06 4 17— ' Z Lis OWNER EMAIL:
<br /> CONTRACTOR NAME: 34 l ticoe.,e cc,.,,5�vu'`-'1\? `�5 4 ,c-s 5crrr�,scsc
<br /> CONTRACTOR ADDRESS: STREET Lig-or Sft'c"-, IA It e t?•�
<br /> CITY 5 h a A pr.?4 STATE�^W '1 ZIP Clg2 IC
<br /> CONTRACTOR PHONE: -15- 2g q_ t 4 d 1 CONTRACTOR EMAIL: -,..Cy, L) -f-?i I I L c-jam'(a,5--�
<br /> CONTRACTOR LICENSE#(REQUIRED): fo 4--.. ( (-EGO zop CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Li I
<br /> PRIMARY CONTACT: 0 OWNER I //CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: LIZ 5- Z-03 - A. Cci
<br /> ,1Cis 4,v^'I (ji -,S,, CONTACT EMAIL: '"1--1 b GG C % ,,q J Go—
<br /> Existing Use of Building: G1 e,-,e,- Contract Price of Work:$ (*COO,VI—
<br /> Proposed Use of Building: fro-,a Heat Source: ❑Gas ,[$Electric ❑Other •
<br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel , 'Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: n
<br /> P.qeC,`r Pry%v,.y S ,,/� '`� 5 `7 C r f gc,4& o I/...e 4-0 ve c;G,,, ( ;via 0,4 cd-
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> •, . `MECHANICAL PERMIT APPLICATION, , ,'. ..... .. .. ....:: PLUMBI' G PER IT A'l PLICATION,: ,
<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 I SUPPRESSION SYSTEM„ry ,„ 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 ,ith the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT t 1 pct._ ©^Z
<br /> 0 •r/Authorized Agent Signature
<br /> /1/
<br /> Da (Revised 4/15/2019)
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