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Elm PERMIT APPLICATION—
<br /> ` BUILDINC�IECHANICAL/ 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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> {Blue,or Brack In.IC Only Pleasel ,PROJECT SITE INFORMATIOSfMggut... , . , , , , ,. W
<br /> PROJECT SITE ADDRESS: 7 /7 751 A `t free e PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> . > V`..- . .Y _ ,.. 0O._ TA:C:t I+LF , ,MATION, alnailMit<
<br /> OWNER NAME:
<br /> 477,4".5,f /'�Aiy(t- TENANT BUSINESS NAME(Commercial): 2.4%FfrAfJ-1/25,
<br /> OWNER MAILING ADDRESS: STREET 7 ci7
<br /> f j 5/1, c� 5
<br /> _ CITY y/y�(pe•f 1 STATE 04, ZIP
<br /> OWNER PHONE: 4'i- - ,2(Z.- 9z4,8 OWNER EMAIL: .4a kQ5 Nd .....00•42--$1-1/1-4.9 f COi7
<br /> CONTRACTOR NAME: 4 =•!.P A f) ,_5e i(/7-Ce-.
<br /> CONTRACTOR ADDRESS: STREET 1 7O1� 47 �.4..)E.
<br /> /
<br /> CITY �`e /� STATE �ii, ZIP ff�!
<br /> CONTRACTOR PHONE: ; (..e^i"2e�~45.2)P I CONTRACTOR EMAIL: a d'y2,y,, X Ee-e'>` D 50/-'4 �4
<br /> CONTRACTOR LICENSE#(REQUIRED): i-;j I, _`) I-10440 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0y 7 q ey,
<br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR OTHER(Please Specify) f le )4€6. K f
<br /> CONTACT NAME: CONTACT PHONE: el5-0 8_ 783
<br /> ������ � � CONTACT EMAIL: 5 r du St,�7�C /C
<br /> T BUILD NG,INF ORMATIO
<br /> Existing Use of Building: RPM't44 ax •T. Contract Price of Work:$ 7 ) erg:°M"
<br /> Proposed Use of Building: / ph-j/ /4 eog 'i Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel CI Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ,�,(" � �
<br /> 1t, 1 k 'F' -cry' / / E i c.)- -e,( Gce,Z7C) /7 .61
<br /> Fi-<C . Cs9725 , vT�lr) . /4i>cs s
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> " MECHANIOAL;PE 3MITIAPPLICATI Otic < .,,y , PLUMBING LE t141>ir A*PLICATI9 „
<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 /> 4IP*1-0*COt Amoo*kotostootomFau SUPPRESSIONSewage 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•• . thorized 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 St- ••ntractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> // PERMIT-
<br /> ►' i1 �f : 9- 5 X0110-oH�
<br /> •wner/•uthorized A,ent Signature Date (Revised 4/15/2019)
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