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<br /> iiiiimi PERMIT APPLICATIOmk,
<br /> 1.1
<br /> BUILDIN I (MECHANICAL/ PLUMBING/SIGI443RINKLER/ 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 or Black,ink Only Pleased . .PROJECT-SITE„INFOR_MATION, _,. r
<br /> PROJECT SITE ADDRESS: /.56c. LZhlo S ! (PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> u CONTACT INFO
<br /> R01AT10N
<br /> OWNER NAME: FJ cpc!(10(_ A.(OUr j es-t Ct..- TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET ��0,' I s-- 6 L
<br /> CITY ev i -` STATE tit)1%” ZIP g$ Z
<br /> OWNER PHONE: X25-- 2 s`q:12-1 t OWNER EMAIL: (kleKr ?f / OG.rCE.0-®N4
<br /> CONTRACTOR NAME: 1 P im2 .---,
<br /> CONTRACTOR ADDRESS: STREET F. TO K (D 2,p U�
<br /> CITY ( i ,�ill/// `S STATE 0-) F- ZIP/8 zt/q�_
<br /> 7• "
<br /> CONTRACTOR PHONE (T7$ '4
<br /> : _ j
<br /> `�j C9(, CONTRACTOR EMAIL: --1,6-,pt ``'1' 67.:l/2+ .. 446.-c 7.1 +' t
<br /> CONTRACTOR LICENSE#(REQUIRED) ( ( /Se' i q O s G CITY OF EVERETT BUSINESS LICENSE#(REQUIR 4 ,
<br /> PRIMARY CONTACT: ❑OWNER 0-BONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: L(Z,r, -7$'q_ 33t:10
<br /> 7064 l 21 42. L L. / CONTACT EMAIL: cif.,-Teri'( E rrii ^ ►ti r1 — L7
<br /> . .. : . ...., > ,.. ., B><III.DING':,1i4PCttN.IA'i`,ii�iiir .-, - a.
<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 OMulti-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New DAddition El Remodel 0 Repair CIT.'. ❑Sign OSprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: •(,..
<br /> l‘i 1E-N4 WA--r<0Z SVC. (..,I y—i rc. F at:,v,- 134 4-4-- a NA.C,1‹.rt.. .h $ti IZ)4
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> . MECHANICAL,PERMIT APPLICATION ..,... . PLUMBING PERMiT..APPLICA t'ION; ,,. .
<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 P„a..rc,o_,.,t_ C....,.�,
<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 1 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 /> 10/4g1---s .lhli PET ,0\,b
<br /> Owner/Authorized Agent Signature ate (Revised 4/15/2019)
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