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= PERMIT APPLICATIOt
<br /> BUILDINECHANICAL/ PLUMBING /SIGNEWRINKLER/ 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 ar Black ink;,Onlly•Please .,. ...,,x ; PROJECTS SITE INFORMATION. . ... , �,.,.•k .,,�._, „.,,., ..�. . t... .. ........ 4, _.....,.,
<br /> ,,
<br /> PROJECT SITE ADDRESS: , , AS•
<br /> A _'__ -- t PROPERTY TAX#: ( `ri.3(L 5ScyOI O0
<br /> LEGAL for new construction: Short Plat/subdivision q fa Cod.it Kot-tot No. (attach copy of long legal description)
<br /> CO TAC Fi DRIVE TloM
<br /> OWNER NAME: Leiv,t PC...41Ae r$\nt`p TENANT BUSINESS NAME(Commerci.I): G 0
<br /> OWNER MAILING ADDRESS: STREET 03 2f2 9.0c, : A-2..-
<br /> YUp±:_____)
<br /> cITY Cx� STATE Met ZIP /
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAMt, j_. .Wi
<br /> CONTRACTOR ADDRESS: STREET Cb X L�esgcf
<br /> CITY SAL.44-0 IA/\t5 STATE WA- ZIP 78.2,1/
<br /> CONTRACTOR PHONE: 701-60(?^PSD CONTRACTOR EMAIL: Ott,t ChCU"-c e iect-I&&;l,00,coil
<br /> CONTRACTOR LICENSE#(REQUIRED): JCITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER -®CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: /1/4)� /. C I'tz ekv�� CONTACT PHONE: '7e f-6c:) ' —/c5-®
<br /> (•� CONTACT EMAIL: t1(, l!I l t4A.. er 'co. coi".
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<br /> »,B..UI 1�1 PI�IFt n "ION . z i ,
<br /> MA •
<br /> Existing Use of Building: _ ji,-CCti"-- Contract Price of Work:$ 5;000
<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 ❑T.I. ❑Sign ❑Sprinkler ❑Demo_1lition ❑Change of Use
<br /> DESCRIPTION OF WORK: O(zs� �Xi Ai L A "_ SF r CU+ `s- f ex.)i L,- /t'4t' s
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> .. MECHANICALS PERMIT APPLICATION,.`: .`>v., .. ... ; PLUMBING,PERM.IIT APPLICATION x:,_ . G:., ., .,.
<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/SUPPRESSIION 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 /> /.�� PER14_51M06-00 )
<br /> Owne .uthorized Agent Signature Date (Revised 4/15/2019)
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