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PERMIT APPLICATIOW
<br /> In
<br /> BUILDING-ECHANICAL/ PLUMBING /SIGN' =RINKLER/ 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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> '��{{ (Blueor Black linkE)nly Please).;:. _„. .. PROJECT S,JTE INFORMA' �O* . h .. :440-. ` . ..,,.. ...�....,:.,.<
<br /> PROJECT SITE ADDRESS: \\' 2 9 EV�.(`,ac PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> _. ... V.ta 0Ste, ,._ _s:g0.... ,-..... 4R ,., ..`, I
<br /> itk OWNER NAME:1,(1,0tkAit(,t/ezI- VC,,(.6 \P,,p,...? t/ t,k— TENANT BUSINESS NAME(Commercial): I4 k..14 e:}<
<br /> OWNER MAILING ADDRESS: STREET ,I I-1,l 1 ' /��,C, l z`-c 1-4^• S i--- (-70 Q��� ` I
<br /> CITY u 1 f Vim,��i STATE 6� ZIP �{/�-7
<br /> OWNER PHONE: `-0 G- q. j ci SGa- ii OWNER EMAIL: , rL�6�./ 0 Vt,V.;C0J ll
<br /> }CONTRACTOR NAME: (vu.,tD� 0✓I, (>,( II 6_0' , V o,, (-kc�. V3e
<br /> CONTRACTOR ADDRESS: SThEET rr 1 'P. r
<br /> S
<br /> CITY r.cG.L tJ wi.G STATE C.-Q14 ZIP q 5
<br /> CONTRACTOR PHONE:25 3- .5 9 J,5 15GI CONTRACTOR EMAIL:0 (--inc..ti 6)t,JcciacIGU,_ CUIAi-,
<br /> CONTRACTOR LICENSE#(REQUIRED)IPI--V-1.l3 4aG reICILY OF EVERETT BUSINESS LICENSE#(REQUIREDj1- 5k-vi\---i-
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> 4- .71,� CONTACT EMAIL:
<br /> Existing Use of Building: Contract Price of Work:$44' 3 6 64 ) . G 6.-
<br /> Proposed
<br /> Proposed Use of Building: Heat Source: f Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> (,,, -fir- £vim `7 5 G c/t V du. 4- ,i 5,0 ( --e....(44‹,(.4---
<br /> ..
<br /> ASSOCIATED
<br /> .est -
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): ,.--
<br /> ., l►rlEC fANiCAL PERM.IT,APPLICATION.,, ,... 4.,.:.a ..PLUMBI i.„'. PE0 T, PPLICATIO 11'. ...,. , .
<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) 1 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, Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System No.of Heads.
<br /> •
<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 /> PERMIT
<br /> 9:0' \- z7-- 202c) M O1 - 012
<br /> Own; /Authorized Agent ' nature Date (Revised 4/15/2019)
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