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® • PERMIT APPLICATIC•, <br /> a. <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / EMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVIC S <br /> 3200 CEDAR STREET, EVERETT,WA 9 201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.g .everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (CC: )(vfl u!, >„ (, j t,i j(y. .� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET , <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: .A l r ; J,5 t I fl t q 1cl• <br /> CONTRACTOR ADDRESS: STREET IC/- sw `2 l t f i c., <br /> CITY -RAln.`Vl U y ' STATE 0 t2.-- ZIP q]o&)J <br /> CONTRACTOR PHONE: L. �' (0Cl2 ' c2/ CONTRACTOR EMAIL: kY r 'nccA CAI psi ,)( -',5 a COYy <br /> CONTRACTOR LICENSE#(REQUIRED): WA A F P,S`I L*0 1 1.12j't CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): LS`lq - <br /> PRIMARY CONTACT: ❑OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: L CONTACT PHONE: � `,> ..Q -I 2-- L-i 2 U4 <br /> 1(tO l I I Ic Iy V, I2)[pl ) CONTACT EMAIL: _..)v n r✓1C") cc.4_1,-,S i,j 5 co -, <br /> BUILDING INFORMATION / <br /> Existing Use of Building: CGYrllr)'1Q,160.L Contract Price of Work: $ I2. I ��t? <br /> Proposed Use of Building: O(rMQ-16-(Gt L Heat Source: ❑Gas ❑Electric DOther <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ,Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair gIT.1. ❑Sign Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: - Inc) c .-r 1 S {Co.._, <br /> Lt.CC (-)oG\c&tt , rew Ci Urc S (AYa Ka it& <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 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 /> 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 y,_l 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 gr ting 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 a instance.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 /> a!_)._ _ , of c i►► / ►C1 Ci 0 -- 00� <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) // <br />