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PERMIT APPLICATION- <br /> LI BUILDING/MECHANICAL/PLUMBING/SIGN I SPRINKLER I 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 1 FAX 425-257-8857 ((E)everetteps©everettwa.gov f www.evoreftwa.gov/permits <br /> (Blue or Black Ink Only Please_:: PROJECT SITE INFORMATION <br /> PROJECT sin ADDRESS: �"f t10 LI eb y pvt I/C. &Ie�> ' 72,0 j PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ,,j Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Pan h 4, thi(4,(A4 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 40p4 0111,I1 <br /> kit.. <br /> Civ )1'J STATE wit ZIP 1 g aP 3 <br /> OWNER PHONE: V OWNER EMAIL: <br /> L <br /> CONTRACTOR NAME: -t j.. . rte. e'`T <br /> CONTRACTOR ADDRESS: STREET Zia) PA-6, C C... <br /> carr E-1/(:.,;:12.k.%-ti" STATE 1.4...14,43-i zip 2 k ) <br /> CONTRACTOR PHONE: 12') '2.5Z-3 I19-'- CONTRACTOR EMAIL: /( at ( e 5°St1'll(itt.L Om <br /> CONTRACTOR LICENSE#(REQUIRED): (�V 63S.5(-72 CITY OF EVERETT BUSINESS LICENSE#(REgUIRED):OO19 C5 <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (L, Z. 50 '--G'-7 Z3- <br /> F-"(I ) cA-Lo CONTACT EMAIL: p-,,, ,e 5 944Waa, G1014.4. <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ ImfIA ,,,,,,_ m <br /> Proposed Use of Building: Heat Source: bgGas ©Electric ©Other <br /> BUILDING USE: I SFR DTownhouse DDuplex DADU OMulti-Family-#Units: DCommercial DAccessoy Structure <br /> T ro ect: DNew DAddition ❑Remodel *Repair DU. Osign OSprinkler DDemolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> p...... <br /> ASSOCIATED BUILDING PERMIT# if a.plicabie: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Miura Fixture Fixture Fixture <br /> count List of Fixtures count List of FixturesCountList of Fixtures Count List of Fixtures <br /> NC—Alr Handling Units Gas Piping Backliow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boller Gas Range Clothes Washer Sink-Commercial(3-comp,prep,ffoor) <br /> Clothes Dryer Heat Pump&Duciiess Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct S stem(Remodel) Refrigeration Drinking Fountain ShtkUtilif,iaund ,mo. <br /> Exhaust Fans(Residential) Commercial Ventllatior _Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC syste) Hose Bibb Urinal <br /> Exhaust Hood(Type iI) Water Heater interceptor-Grease WasteNVater 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/LogRoof Drains Water Heater <br /> SYSTEM J SUPPRESSIONYSSTETE <br /> M Sewage Ejector or Sump Pump Other: <br /> 'later oppress on ystem To.o eads <br /> Chemical Suppression System No.of Heads <br /> ACIKNOWLEDGEMENT,L 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,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /..4 1 s A_ PERMIT# <br /> 1) 1111102-0 IAr I <br /> 4 <br /> •wrier'Authorized Agent Signature Date (Revise. 10!10/2018) <br />