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PERMIT A.PPLICATIO
<br /> BUILDING / ECHANICAL I PLUMBING I SIGN I PRINKLER/ 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( www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT.SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 100 . )4 r,f\P-..Lt. t,a, i z.v e auvs E PROPERTY TAX# ".(:;.,,0 5 t%0 0 )0 t *7 O O
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME:NM --$Ac WArrogravi PAW& NA ILPTENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET t 0 4) rt 3-.a!.'- AV 5 ", 't:'_ r r ) _.()
<br /> CITY a,: A' `"1,,,
<br /> STATE 1i4 ZIP 10 4
<br /> OWNER PHONE: 7 0 - z 7 -S�.LI 1 OWNER EMAIL:
<br /> CONTRACTOR NAME: SU a l-ii -.Y 3 two. Llit% °-`:4 I K1 C.e
<br /> CONTRACTOR ADDRESS: STREET %Z 9 0 A/ ail/N EA,/ 254,V.Q -r-E 1S
<br /> CITY i'AtZ,'‘) A/ ',,rrV STATE /t.,,7 zip 2 3 7 i ci
<br /> CONTRACTOR PHONE: 90,3-is -01 5 , CONTRACTOR EMAIL: "'C EP CA 1,447, /,v 6_co ivi
<br /> CONTRACTOR LICENSE#(REQUIRED):+•�lji „"i,;."1�,\�1 4(`"'`t j" t CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 2,_3 i 1
<br /> PRIMARY CONTACT: 0 OWNER 13"CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2.06 _c c z._O o"ev.' .o
<br /> $d-4-10.\ se,c),/D CONTACT EMAIL p 7 _. S. .1°. ,. ,:. (1.'l
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: /4,4.,` `. i- ;` 0, )4 s.1 Contract Price of Work;$ /2 6U 0
<br /> Proposed Use of Building: /&"ct L .17'i/ Heat Source: ❑Gas Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Wiulti-Family-#Units::^6 t, ❑Commercial ❑Accessory Structure
<br /> Type of Project: ONew ❑Addition E°R�+emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: in 1., t�Ka=..,i'�"`- $tt <.) ,�L is , , �0 1 \ . 'I L°\ 1`x . 0 A � , ,
<br /> / r',,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): N IA
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture
<br /> Ciount Fixture 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 1 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:
<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,or lam authorized by the owner of this property to perform the work for which application is made,
<br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> �/ City of Everett Official Use Only
<br /> • /4'�-ri PE T�`i61-- D 12)
<br /> Owner/Autho zed Agent Signature Ddte (1?evised 4/15/2Of9) I ,,
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