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® PERMIT APPLICATION <br /> BUILDING / MI CHAN CAL I PLUMBING I SIGN SPRINKLER I $EMOLmON <br /> CITY OF EVERETT PERMIT SERVICES <br /> E V E R E `=i C3i 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:7 ,L /r^'i' '`l 4.1PROPERTY TAX#: 43Q-$�ETI1%�` 356,Y) <br /> LEGAL for new construction: Short Plat/subdivision� Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � v t f/Z ry LC 19z9 <br /> L- TENANT BUSINESS NAME(Commercial): /WA <br /> OWNER MAILING ADDS: STREET 6/S Alit/ ii‘piftla 6Y; <br /> CITY ( O STATE ZIP S77 <br /> OWNER PHONE: OWNER EMAIL: <br /> ��JJ <br /> CONTRACTOR NAME: 'I'' '7L'A_ ,7 '4 '4 �� <br /> CONTRACTOR ADDRESS: STREET 3/, PS-Jed� • 52:-- Q/'y <br /> CITY . .> D'1#1 i � STATE 54 /�, ZIP 9 (J <br /> CONTRACTOR PHONE: VG �a/a'cSy� r CONTRACTOR EMAIL: %; &i 6666&y'GP,foc; rf j <br /> CONTRACTOR LICENSE#(REQUIRED): ��/�j� CITY OF EVERETT BUSINESS LICENSE#( EQUIRED) �/���Q <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:I �/ CONTACT PHONE: pit)rZ // <br /> �jl Q/ �(,PAr/O CONTACT EMAIL: G 414„, L-91,g,ey,-j •car,L c/Ki,ecw.,i <br /> BUILDING INFORMATION <br /> Existing Use of Building: ,/ s zar9K Y Contract Price of Work: $ <br /> Proposed Use of Building: 6:S f,o 9#t t Heat Source: Zas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: aCommercial ❑Accessory Structure <br /> Type of Project: CI New ❑Addition ❑Remodel ❑.R¢epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ad' <br /> i eyp^�7�Ii / / 4vp,i_vi �i"5 /5.),_ !,, L() //s q' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): , D7 '"Oc 7 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <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 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 r Roof Drains Water Heater <br /> SPRINKLER/SUP SS1 SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System MI o.of Heads <br /> Chemical Suppression System ' lo.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed is appli tion 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 gra . f 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comp) with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PER IT <br /> --r" /- //4?//b C) ( _- 60 3 <br /> ir/Authorized Agent Signature i /Date (Revised 4/15/2019) 1/ <br /> (%Z— <br />