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PERMIT APPLIC
<br /> BUILDINCIECHANICAL/ PLUMBIN / RINKLER/DEMOLITION
<br /> EVERETT CITY OF EVERETT PERM VICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 j FAX 425-257-8857 j(E)everetteps@everettwa.gov j www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 14.: (f' (' r u�P.reti ti&GPI t C PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot o. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ) alto t!r t TENANT BUSINESS NAME(Commercial):( ek)I ,L 1 kJ(r- L.--,jj1 ( LC
<br /> OWNER MAILING ADDRESS: sTREEr I2 q b Z ede net •q- , G .to .`
<br /> crt L-v P Lr f_i i. Lc) A STATE W A ZIP `-r g Z O cy
<br /> OWNER PHONE: OWNER EMAIL: L�[�l �01 ckel i a 1. t, i. C(�-
<br /> CONTRACTOR NAME: i.�y,�,�L,.--a_�r] r
<br /> CONTRACTOR ADDRESS: I STREET p�j 1{ /Z1 s 5' r� kg, 0
<br /> city I�.ir'T WAY.C�C. STATE Ut, ZIP 6N(/C-,
<br /> CONTRACTOR PHONE: Lj' 4 - 4.L ( -0 2 7 7 CONTRACTOR EMAIL: g pe,„.fa 6 EdQ 0i . � '‘
<br /> CONTRACTOR LICENSE#(REQUIRED):S I`F, Mr M ]'d 3 L CITY OF EVERETTIBUSINESS LICENSE#(REQUIRED)6---r6m,
<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR jaOTHER(Please Specify) ()cyQ.l,1,
<br /> CONTACT NAME:r, �� CONTACT PHONE{ .LC(,')i1 _ �CtCa q
<br /> ' G,L'+"'r 3 I,yvu l L L C. . ,CONTACT EMAIL: t,L4i 3 i c r en,1.�( (�/ yVl0..l� ce,)4,1
<br /> 1.1 v BUILDING INFORMATION J
<br /> Existing Use of Building: / Contract Price of Work: $ E!<h�`,:.----
<br /> Proposed Use of Building: � �
<br /> I '�' (\ ,,,,,a`)`) 4 Heat Source: ❑Gas lectric ❑Other
<br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: n f'
<br /> .vA-Sfi 1 S z, a`-( G CLAt�u f I e...5 -OM- `'lct_C�L,0 0 - , , ,
<br /> U ,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<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 /> 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 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 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 I 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 /> i y/`' '�0 City ofEverett Official Use Only
<br /> PERMIT2
<br /> / ,2 -2 ;Zc> D 5
<br /> caner/Aut Ind Age t i um Date (Revised 10/1W2018) (-1/Z)
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