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• PERMIT APPLICATION <br /> ire.)-1 "''' ' . BUILDING/MECHANICAL/PLUMBING!SIGN /SPRINKLER!DEMOLITION <br /> CITY 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: (D ER TJ. &;CClM $T, PROPERTY TAX#:(O(Q I9_6000(YT 700 <br /> LEGAL for new construction: Short Plat/subdivision - Lot No. (attach copy of long legal description) <br /> 1 CONTACT INFORMATION <br /> Wn <br /> OWNER NAME: C©r, Q_1.6.4 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS:.. stREerr(,i.th.�j/J. geeck( ST ^. �}Q.^m_ <br /> city (w1��",4E t STATE WI'1_ ZIP X/f-03 <br /> OWNER PHONE: Gins-350-co-703. OWNER EMAIL: . \ptn4Cpf${- 1kECedlcV rCij;iN) <br /> CONTRACTOR NAME: 'I)V I Yi(/1 `f _.. J __ _, <br /> CONTRACTOR ADDRESS: STREEr <br /> city - STATE ZIP, <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): - CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: D OWNER ' 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:. <br /> CONTACT EMAIL:. <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:.$0_) Q 00 <br /> Proposed Use of Building: Heat.Source: ❑Gas ' Electric ❑Other <br /> y <br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex ADU ❑Multi-Family-#Units: - ❑Commercial ❑Accessory Structure <br /> Type of Project: New ❑Addition: ❑Remodel. ❑Repair OT.1. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:. <br /> ,Je,,.., , 29ori t d-eA ec P\O <br /> k. <br /> ASSOCIATED BUILDING PERMIT#(if applicable):'. <br /> MECHANICAL PERMIT APPLICATION` PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures FvL.m List of Fixtures. Fixture List of Fixtures .Fixture. List of Fixtures <br /> Count .count Count Count <br /> NC-Air Handling.Units Gas Piping ► Backflow Preventer(Inside.Bldg) :I Shower,Tub,or Combo <br /> Boiler - Gas Range I Clothes Washer. Sink-Commercial(3comp,prep,floor) <br /> l Clothes Dryer Heat Pump&Ductless \ Dishwasher lg. Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration - Drinking Fountain - Sink-Utility,laundry,mop <br /> I Exhaust Fans(Residential) Commercial Ventilation Floor Drain k Toilet _ <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) I Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> I Exhaust Hood(Residential) _Wood Stove - Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas .......2...."•-•Wattaalitaed <br /> Gas FreplacellnserULog Roof Drains <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other. <br /> Water Suppression System No,9f Heads - - <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEMENT.'1 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!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 ROW and 296.200A WAC. <br /> I) / ! /J /Tj-, (C//ityy�of Everett Official Use Only <br /> r D`I itt-Jj' PERMIT 6 Di `' ooi <br /> Owned ent S ature Date (Revised 10/10/2018) �Ih <br /> !l <br />