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PERMIT APPLICATION
<br /> 1111.1111
<br /> BUILDING CHANICAL/ PLUMBING/SIGN I'I*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 /> B'ue olr Biack Inds Onl. Pease a PRO ECT'SITE INFOIRMATIO `} g
<br /> PROJECT SITE ADDRESS: 7 Z \4b0-(T / ...,\/. .__ PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ©#ITaaT 100:10 A0TION
<br /> 1 OWNER NAME: t1/4,A\V., t_K't-A TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET Z2.4 14 ni T ,L\V 1 -
<br /> CITY —VEI ,�� STATE ZIP 9'6
<br /> OWNER PHONE: OWNER EMAIL:
<br /> -fit CONTRACTOR NAME: C., lAe.C.it yrs c
<br /> L�
<br /> CONTRACTOR ADDRESS: STREET ,, ,5 v/ ,1D\AVi ,,^
<br /> CITY � V\,- STATE ZIP ' / �►
<br /> CONTRACTOR PHONE: CONTRACTOR
<br /> LE AIL: _'
<br /> CONTRACTOR LICENSE#(REQUIRED):° Qin - CITY RED):F EVERETT BUSINESS LICENSE#(REQUID(/`
<br /> 1,(4)
<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:`t` 42.5 -�3n— 35-i
<br /> �i )---INP---k.1143CONTACT EMAIL:
<br /> .,,,v Ot004.00:10: .R.MA iO
<br /> N, x
<br /> Existing Use of Building: . Contract Price of Work:$ C]d
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: '/,,, F)rk.e. PL A,.G. I
<br /> rtr
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> PLUMBING PERMIT APPLICATION 4,.
<br /> �, ..MECHANICAL`PERMIT;�1PPL1CATI,QN. .' ,., �, ,:..,, .,...5 _ ..
<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 /> .,SPRINKLER/.,SUPPRE.^,SION,SYSTEM, Sewage 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 being authorized under any circumstance.lam 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 /> Pr no...._
<br /> Owner/Autht ent Signature Date (Revised 4/15/2019)
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