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• PERMIT APPLICATION <br /> UM <br /> BUILDING /MECHANICAL/ PLUMBING I SIGN IIIPRINKLER I DEMOLITION <br /> EVERETT CITY 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 oc Blaek Ink Only;Please) PROJECT;SITE INFORMATIOif <br /> PROJECT SITE ADDRESS: 32/y QgCIi Oft PROPERTY TAX#: . <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> I. .. ., : 'CONTA'CTINP.ORMATION R. , _ <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE LP <br /> OWNER PHONE: 'OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> MY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: grOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: bivc S er CONTACT PHONE: a06, 425."5.-- 7 —ec9 <br /> CONTACT EMAIL: 6.5 A/4/tt 2 At.Cy. cony <br /> is • ..,. _. ' BWLDI461NF.bBN11ATidfi1 '/...ice._ "ff,..� <br /> ,r <br /> Existing Use of Building: Contract Price of Wor : <br /> LJEI rc---❑A <br /> Proposed Use of Building: Heat Source: ❑Gas ec�T tlw_r <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: p0V1-35Dv. OF sveic Witt, /44.6 Ars .1 oc 1._to,sry' <br /> Aiith S z$s . ,371 4 iwig ?'wO SETS vi ALAr/S <br /> ASSOCIATED BUILDING PEA MIT#(if applicable JR f 7f t77: <br /> y.. <br /> MECHANICAL:-P_EWMIT.4PPL[CA, 14t, ...... PLUMB!NG\PERMJTAPPLICATION. <br /> Fixture List of Fixtures Fixture List of Fixtures Fixture V Fixture <br /> Count Count 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 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 /> '(`;SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System I 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,on 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 /> -' (//nJ -_ //— F�L{�e City o\fEverett Official_f Use Only <br /> Owneruee Ilia:neat-- PE `� \� \ n ZJvk ` t <br /> thorized Agent Signature Date (Revised 4/15/2019) /I <br />