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PERMIT APPLICATION <br /> 000,0, BUILDING I MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> AlliriCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: SH 0 q s 79- a \Rea* W A 9%703 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:LVrlArvr (U 5 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET O{ ri Cn raW 5� <br /> CITY S�-c STATE `�,:� ZIP Q si(o q,- - <br /> OWNER PHONE:?O(0-%OZ- %-{2V-3 OWNER EMAIL:C.,L..,-IS S Q,. (0,L;bu---re. , cpvvt, <br /> CONTRACTOR NAME:CAAI`k J,vQ'tkr S-C Alio-e n- (cw-n sz..„ <br /> CONTRACTOR ADDRESS: STREET 90, M CSI rel.'.,.) Si— <br /> errs( S eat l-e- STATE WA ZIP qg(0 9 <br /> CONTRACTOR PHONE 20(9_-%o' —'-i t\ CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: V,OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building: 5 l j�, Contract Price of Work:$ ,U,O OU,G -' <br /> Proposed Use of Building: 5 i E-k,r,s.,I' Heat Source: ❑Gas 0 Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial , Accessory Structure <br /> Type of Project: 1 New ❑Addition ECRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF uWORK: e. '\-t, 0 0A_ ,✓D (^'U� (J <br /> orcA; ` <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 /> 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 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 'th the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> (5(-, <br /> 11,----1 <br /> _�Cl PERMIT lA, `V1 A 0 1 , 00()) <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />