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IIIIIII IIII � PERMIT APPLICATIONa.
<br /> BUILDIN�JILECHANICAL I PLUMBING /SIGN I' IIRINKLER/ 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue oru.Black Irik,Onitei*ase),i ..wgTROJEGT:SfTE,,INFORMATI.Ott, ,i g& ..,, .w ;.fi et ...,,.,...; ,..... ,_
<br /> PROJECT SITE ADDRESS: t, 132.f t by f cu . PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> _, a),:i: ...,.CON "ACT,INFORMATI0I M, o . .. t.. t i, a
<br /> OWNER NAME: Wo.,/it +G4. 7-tivtt,lj`rq V.S.# IAjp, TENANT BUSINESS NAME(Commercial): I-0-
<br /> OWNER MAILING ADDRESS: STREET 1.5Z4 C.C7LASN1 ,,/O.
<br /> CITY C�N/ ` STATE b1/4).4 J.4 ZIP 44i g Z{)) 1
<br /> OWNER PHONE: S Zti-Ont9 OWNER EMAIL: -..Vir ei, Geentirm--te.., ver . tit,
<br /> CONTRACTOR NAME: K0) f4 t9 D-. 0.1 07,....1, 11.40
<br /> CONTRACTOR ADDRESS: STREET 2,.2.1 "71'I1 . M (1-- LV
<br /> CITY trairrtt, i STATE LA)pi, ZIP 9$1
<br /> CONTRACTOR PHONE: 745-4,='1i,J sgemsna CONTRACTOR EMAIL: j ;1.... Fe.„ oft— tolf. yA. GO
<br /> CONTRACTOR LICENSE#(REQUIRED): 'j I$Att"t$t,,(3.7 ss(?,,,,r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):4•
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: z,0(o-56'5-al 4-4Q
<br /> (G„ f ? CONTACT EMAIL: DG' Ie. a e,G, ,hq,.(.5 •(.497,,.,,1
<br /> `' :BUILDJNNF0RiFION4° z
<br /> Existing Use of Building: !10 9t17 L.. Contract Price of Work:$ 7(.,b Le<-
<br /> Proposed Use of Building: J1 $f+1f7grL-- Heat Source: gGas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ,PCommercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> Pc - r-4 vF L*6ti rich l r"Pe +C-t•-+t'
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> _.,v MEECHANICAL'PERMIT APPLIBATjION :.,, :. .,..»P,UMBIrNG,PER Ii1 AI'PLIO)IT1ON ..
<br /> . ,
<br /> L
<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 S14#1M 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.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,
<br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> 1, .. • 7 7:?-Za1 P \ Or -- ©`Ce)
<br /> 0 . :, • • horized Agent Signature Date (Revised 4/15/2019)
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