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IIIIII PERMIT APPLICATI 'III
<br /> leilBUILDIAL � MECHANICAL I PLUMBING/SIGNftPRINKLER/ 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'O:*k*lease).. PICC ,1EGT•SITE INFORM!4THi'S .. ...,, ..a ,.,... F' ..
<br /> PROJECT SITE ADDRESS: J 4 O 5 2,11- 51 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT4NPORM.0ION
<br /> OWNER NAME: e'�e('e„uJ d di t TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: / STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: L'I ? -��j1 l 2, ? OWNER EMAIL: ec'CwL g"-',,,c, D,A ri ,C,= 12,--
<br /> CONTRACTOR NAME: (-C G "6 Clt d'k•�Ci•-- Cf vt X,e.A4t7A— t-k-Ce,1/49. LA.,/,01" t(---
<br /> CONTRACTOR ADDRESS: STREET 75 1 i G-ce e„,,,W v 42- 1Y .4')F6 I
<br /> CITY `/ e"Ce tii Z STATE `Jc,.,""' ZIIZIP1 R j a3
<br /> CONTRACTOR PHONE: 2 6)6 -- 7) - b-66- CONTRACTOR EMAIL: e �4Su d et -" %e%ute V
<br /> CONTRACTOR LICENSE#(REQUIRED): \,,06,,,,,,,, 01:::+-W(916pg CITY OF EVERETT BUSINESS LICENSE#(REQUIR=i):
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) Cr) S 2 �–tlil
<br /> CONTACT NAME: CONTACT PHONE: 2 61'6 --2-F) 1 5 ,5-
<br /> L--`C':C_ (�1�C�. ,C V CONTACT EMAIL: eS'L�C P S a 00('' _59LA..sem® ® `C`Er
<br /> BUILD NoI Po.n-,00to - ..
<br /> Existing Use of Building: Contract Price of Wor .$
<br /> Proposed Use of Building: Heat Source: ❑Gas Electri
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: El Commercial ❑Accessory Structure
<br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: Ac A` a 1 fc tl- *tit t 1,6, kt ee<i `i 2 _.
<br /> '4G
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> z. IMECHANICA1.;PERMIT*101#1.40**, fOOPTai NORINPEK*14140:***0:00011tAP*00;itiTION ,: .- - ;,,:ir-i ',A,;
<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 Ventilatior 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 /> SPRIN,KLER•I 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.1 am 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 /> PERM ), — Or �
<br /> 16 .
<br /> Owner/Authorized Agent Signature rate (Revised 4/15/2019)
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