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PERMIT APPLICATI _ <br /> BUILDING / MECHANICAL/PLUMBING dr I SPRINKLER/ DEMOLITION <br /> E V E R E T TCITY OF EVERETT PERMITS •• CES <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7CgC/� Har.,)1t' i p‘..) < PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 4c p p`/pss TENANT BUSINESS NAME(Commercial): err �►DVeSS <br /> OWNER MAILING ADDRESS: f STREET J 74 OS- �- y-�d1 � P� 1 <br /> CITY ��'t/n/4 STATE LA, ZIP <br /> OWNER PHONE: y6C1 •_ 201 — ----2_B 0 OWNER EMAIL: <br /> CONTRACTOR NAME: 5-p 5) <br /> CONTRACTOR ADDRESS: s EET/ /7jCjf }-Ik.,jl qa 'IF A <br /> CRY 1 r f P e / STATE ZIP 9� 'SL.Q <br /> CONTRACTOR PHONE: 4,2-r---,2P31 <br /> �7-6;y)57.2- CONTRACTOR EMAIL: S _1 4 AL,01, • C6� <br /> CONTRACTOR LICENSE#(REQUIRED):�r --D S�,f qz, T1) CITY OF RE BUS dU <br /> ESS LICENSE#(REIRED): S3 4720 <br /> • <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: `t'�'S' — 7_ O ti <br /> ? Z <br /> T ems• pek___ CONTACT EMAIL: c2�J",- ' tyJ c <br /> r, : (m ^ <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ tea°•00 <br /> Proposed Use of Building: 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 ❑Repair DTA. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> e15-"-(74/I C4CA/We 1 ‘-ejiLtr (-)-% --f-te- kla q <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C-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 /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.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/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 /> J /-2-—7 ,� —I61 0& 003 <br /> Owner/Authorized Agent Signature Date / (Revised 10/10/2018) <br /> j7 ' <br /> 7i <br />