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® PERMIT APPLICA T IOI
<br /> BU LDING MECHANICAL I PLUMBING I SIGN i Q PRINKLER 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 1 www.everettwa.gov/permits
<br /> (Blue or Black ink Only Please) PROJECT SITE INFO•MATION
<br /> PROJECT SITE ADDRESS: 10041 W (*A „L L.,;n;',, 13 L'b). PROPERTY TAX#: `-'_.`7"0 5 \'SO 0 (0:t .70..0
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME:MA("1,�4\ i.t?+J J y p j pAck NA L'TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET ISO 7i FTfri 4V r STFLit 0 r; ';)
<br /> CITY 41'" ,, STATE O/4 k zip 4 E )0`mot
<br /> OWNER PHONE: Z 0 t: i -5 ` L I OWNER EMAIL:
<br /> CONTRACTOR NAME: yD,v 6 r,? %". , ',' t m w",,,
<br /> CONTRACTOR ADDRESS: STREET 6Z,9 0 (AJ OI/y 0 EA/ 5 4,V.0 3-r E 'g
<br /> CITY Ahrin 1""/iJ t lTti, STATE lb ZIP -izx ci
<br /> CONTRACTOR PHONE: Z,0c '>Z 1' -01 5.5 CONTRACTOR EMAIL: ti i, @ t.,._. °t -, q..,1
<br /> CONTRACTOR LICENSE#(REQUIRED):ZQi i, K 0�k.�el I; CiTY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 w- "3 4 9
<br /> PRIMARY CONTACT: 0 OWNER ®°CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: '�0 6 _` a7.._00%2.
<br /> 1?0°42„t�1? Zo°,,,ID CONTACT EMAIL tt' q t . 'fit,,L.' F_\tst. �
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: f;I t q t.`'J s} + Contract Price of Work:$ /b d 3 Z
<br /> Proposed Use of Building: ft1QL T1 c r Heat Source: OGas Eilectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑,,�tDuplex ❑ADU R1 ulti-Family-#Units::: ‘ ❑Commercial ❑Accessory Structure
<br /> —
<br /> Type of Project: ❑New DAddition f�Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition OChange of Use
<br /> DESCRIPTION OF WORK: .1,'jiw t„a,4c5 4iR.3) 15 .i ,? m), w ; 0,i 'f , �B w , o x2.0 t - 7
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): N IA
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> FixtureFixture Fixture
<br /> Gaunt List of Fixtures Fixture
<br /> 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 /> butt System(Remodel) r Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatiork 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 /> YVater Suppression System INo.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.1 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 /> City of
<br /> ofEverett Official Use Only
<br /> [PERMIT ( ___.0 ��
<br /> Owner/Authorized Agent gnature IV?
<br /> (Revised /15/ 1
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