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PERMIT APPLICATION <br /> In <br /> BUILDINGCHANICAL/ PLUMBING/SIGN /j INKLER� / DEMOLITION <br /> 32 <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black,Ink,Onli,Ptease) ��ccPROJECTSITE,INFORMATIOt .. ..:., . K.. , , ;., ,.. . . „,. .£... r ,.. ,' <br /> PROJECT SITE ADDRESS: �� Gft%2ktezeeL - PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. _ (attach copy of long legal description) <br /> COtVT,AcT INFORMATION <br /> OWNER NAME: . TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET ./1/7* ��i�j a <br /> C��ez�l/c- CITY N/ STATE S%O� ZIP <br /> OWNER PHONE: /7›...5"--/—P&---M2> OWNER EMAIL: <br /> CONTRACTOR NAME: .-kd — D L Gt e4' <br /> CONTRACTOR ADDRESS: STREET <br /> CITY 772 — $7/2. STATE ZIP <br /> CONTRACTOR PHONE:77 2- s 1.2 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): jCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: f ,aefxdateoe CONTACT PHONE:/z��— 74?2—cf <br /> CONTACT EMAIL: <br /> Existing Use of Building: Contract Price of Work:$ <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 IRemodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: / <br /> 1A-41+ fySP. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL,ft**** ,APPL0CATIO#+Ifi a ,.x. ..'. , PI,UMB1NG PERM„I L(Cl' TT P, IO i1._ <br /> FixtureFixture 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 ,2 <br /> Boiler Gas Range Clothes Washer f Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless ' Dishwasher A ci. Sink-Residential(kitchen,bath,bar).j <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilator Floor Drain .‘.3 Toilet 3 <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 .1 <br /> SPRINKLER,]SUPPRESSION 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.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 the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> . lAutho- (Agent Signature Date (Revised 4/15/2019) <br />