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imii PERMIT APPLICATIO <br /> al <br /> BUILDINGOECHANICAL/ PLUMBING / SIGN / RINKLER 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 or Black Ink Only Please PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: <br /> a (o f"'1 v'Vv.e \ (' 'LJ)' 1 ?c, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Poo-)t, /7 6 &la.I, -1.a TENANT BUSINESS NAME(Commercial): <br /> z <br /> OWNER MAILING ADDRESS: STREET a 4( 7 /14,<kr Lne V L e.4-1 r: <br /> CITY \5rre 7 STATE lit,,!O. ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: A &j 'c 1t-1 � �S L <br /> C ADDRESS: STREET t <br /> CONTRA TORA /`�Q' J'4� D CfA �.,y /"� <br /> CITY (�1!`V 4' (�(�( ) STATE *Lim, ZIP l e.o .c?v <br /> CONTRACTOR PHONE: c„,4Z6 c --Teri 3$( (p CONTRACTOR EMAIL: 'C-ici VE . ' 9 A.i/ 'I-y h-i-7 trey @ 61.rici i l <br /> CONTRACTOR LICENSE#(REQUIRED):A &i A L,I-1 . 86 T i l CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT:DOWNER ACONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> )01 U,e ZOC C-1 ) V. aCONTACT EMAIL: <br /> J BUILDING INFORMATION <br /> eV <br /> Existing Use of Building: 'We$t t r Contract Price of Work:$ 1 Dbf)• <br /> Proposed Use of Building: Heat Source: as 0 Electric DOther <br /> BUILDING USE: XSFR DTownhouse ❑Duplex ❑ADU 0 Multi-Family-#Units: DCommercial DAccessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �� <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 /> NC—Air Handling Units 0 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 /> l 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 /> City of Everett Official Use Only <br /> (4.....71::....ss t._ck PERMIT v;m..... o�� <br /> Owner/Authorized Age t Si ature Date (Revised 4/15/2019) <br />