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® PERMIT APPLICATION <br /> iri <br /> BUILDING l iiiECHANICAL/ PLUMBING /SIGN / tit 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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: vl,l 0 4'. 364 1 U C, ' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ( L pert I ii'T lO n,5 La-TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET`G/ `7 Sr Ai f l e [ -e y <t S.f /0.5-`/ r /�3 /� /� ///��� <br /> CITY jO l/ <br /> A kc)-4_ / STATE v ///� ZIP `/ � / /` <br /> OWNER PHONE: — V (� OWNER EMAIL: O '. ' 49' , •COb / r <br /> CONTRACTOR NAME: C le• --e m C0,7t r vl( 'f lop L. L C <br /> CONTRACTOR ADDRESS: STREET /6 6,/ / 1\1 F G I al CG src (1-p t'7 (�///�/Ci y' <br /> CITY (5 I��/ J 0v).-1 is STATE ��y- / ZIP 2 g, <br /> CONTRACTOR PHONE: L (26 �— I/,-- »lc CONTRACTOR EMAIL: ' 1 III <br /> CONTRACTOR LICENSE#(REQUIRED): C L F f E /\/ cl---i'/(,ID CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) \ <br /> CONTACT NAME: CONTACT PHONE: 706 — l D --3 6. J <br /> (/e I� 'lie SS-eKJ / CONTACT EMAIL: C`Y' 2J Q� �/�i7 . 1 ,6,5„r„BUILDING INFORMATION J <br /> Existing Use of Building: Contract Price of Work:VII LU c)(:, <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 CI Repair ❑T.I. ❑Sign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <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 /> 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 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 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 /> ��°14' j/,, //) q PERMIT# <br /> b L ( <br /> L <br /> 0 •- •uthorized Age, Signature Date (Revised 4/15/2019) <br />