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PERMIT APPLICATIO•1, 131111•6141U
<br /> BUILDINiECHANICAL/ PLUMBING /SIGN I RINKLER I
<br /> diMOLITION
<br /> EVERETTCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> 1010W43414111- :e P e e & a, ` O f tti ,e �I? Fy , .4 ., 'e f�`+- 0,,, �. ;
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<br /> PROJECT SITE ADDRESS: flu 5 3efe,{ Mau 4 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision No. (attach copy of long legal description)
<br /> OWNER NAME: (ffyi I1 u), 1 vaYat40 TENANT BUSINESS NAME(Commercial): 1 Ai pi„ f rim
<br /> OWNER MAILING ADDRESS: STREET I ZZ- sr) i,b Lo 0-i- ibv61CITY ( / STATE a ZIP (fili2 j 2e)
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<br /> OWNER PHONE: 12, -- LWanprrm ya,h(8
<br /> OWNER EMAIL
<br /> CONTRACTOR NAME:
<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: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> w* i.., . M.� ", Fid tT } ��I Q�u►'..II.F© �'W 'I'L F i r
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<br /> Existing Use of Building: ku/ ( Contract Price of Work:$
<br /> Proposed Use of Building: Na P ��O , - Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: • ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition CI Remodel ❑Repair ❑T.I. OSign ❑Sprinkler El Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> F..`. I011l 01„. 0:071 I*A0L01T0:01 ': r ., ,' 5... 0.00 . „ t 1, 11 A' IoN ,j .
<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 /> R KJER ,SitPRE$ G "'IST 1, Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System No.of Heads
<br /> ACKNOWLEDGEMENT:1 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 lam 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 /> atitiut C/tl`—eo"o—`�
<br /> NV WiPERMIT# ?)k,o1 12,...06)2)
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<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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