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Num PERMIT APPLICATIOt
<br /> Nil
<br /> BUILDIN—IIECHANICAL I PLUMBING/SIGMWRINKLER/ 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 I www.everettwa.gov/permits
<br /> tBlue ►r Black Ink Oi iy Please).::. .. . , k PRR.JECT SI rE INFORMATIO ..,. ,r, ,, . ,u , , , Sg, .. ..,...
<br /> PROJECT SITE ADDRESS: PI?Pi r`,.PL. SAc- `l lecj\
<br /> evice'e�(- (,.)c. PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> gaz , 3 :;,,.,, _ . r r EO11TA TffiNOilRliW101d. . . . . .1irg` ... gag ,_ M . ,
<br /> S.
<br /> OWNER NAME: -)-p e r-,c,f? TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET I-1 l'{ r-lc'-.P0` 54-
<br /> CITY
<br /> -CITY erai7..G cc 4- STATE LUG._ ZIP Cl$2- 01
<br /> OWNER PHONE: +.113-- 'L 1 1,-,-,...V15 OWNER EMAIL:
<br /> CONTRACTOR NAME: Qw1,c,j- sc........„, al c.5 (..-a o-e r�S
<br /> CONTRACTOR ADDRESS: STREET 23\1- 4-1..j%Ira fl a•G L
<br /> cm( Ar\,. cac}--G) STATE L.'s-1G- ZIP R'aZ2-1
<br /> CONTRACTOR PHONE: 412 5-- 3'-11, —o y 1--} CONTRACTOR EMAIL: ?„",y,E. -sora-r4-T.S @ ccv-•.o.0 _cam r--
<br /> CONTRACTOR LICENSE#(REQUIRED): p 1._ 3v J4, CITY OF EVERETT BUSINESS LICENSE#(REQUI ):
<br /> max. k : ten
<br /> PRIMARY CONTACT: la OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: ,0--6 t ti k,t P7 CONTACT PHONE: +¢7.._5--7,1 _ .? 3 1 3
<br /> CONTACT EMAIL:
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<br /> Existing Use of Building: Contract Price of Work: q-5-e)• vb
<br /> Proposed Use of Building: Heat Source: "A Gas 0 Electric ❑Other
<br /> BUILDING USE:'igaSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: -• mercial ❑Accessory Structure
<br /> Type of Project: ❑New ®Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: a nc) dve..404Li,, a/`� e�'�S vZ�
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> •IIIIEG IAMICAl PERMIT,(11PPLI ATIOI+I • ,.. . r..-.PiLUMByN PER fIIT Al'l"LIC411:00a ,., ,....,:....
<br /> FFixture Fixture
<br /> Crount List of Fixtures Countxture List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> NC-Air Handling Units I 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 SystemNo.of Heads
<br /> Chemical Suppression System I 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 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 /> PERMIT
<br /> OCQ Co
<br /> n- 'uthorized Agent Signature Date (Revised 4/15/2019)
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