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0 PERMIT APPLICATIO*
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<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ 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: 2...9 30 g%)c 4ej' / 1,y PROPERTY TAX#: OD c{3c//I)ak...)-", 3 C C-;
<br /> �t �,Lf�t ��gI1•3r�c1
<br /> LEGAL for new construction: Short Plat/subdivision E/e.-t� PO- o't"y� LOi N0. (attach copy of long legal description)
<br /> CONTACT INFORMATION F'AS r 5,lii4
<br /> OWNER NAME: `1 i i I .,d et /4 t/P5 i cY'6 C LC TENANT BUSINESS NAME(Commercial): r •
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<br /> OWNER MAILING ADDRESS: STREET / 3i3 4iALI_ S%,ef/T
<br /> CITY t i e,--e -74" STATE i<4.,, ZIP 1 9 6 Li l
<br /> OWNER PHONE: 111,5 - 2-5 L-3i `1/ OWNER EMAIL: A 7fvin-C r-t i(L; & C- i ivACNk . C.r-vh
<br /> CONTRACTOR NAME: A/c, r p s 0 i-sue hie-AT/AJ 0 4 nei A/(-7
<br /> CONTRACTOR ADDRESS: STREET 3,7 3 i. B a t.` 5T "t/6_
<br /> ,CITY /•'LLL%C Ll t C.0 STATE 4.--/A- ZIP �G 2- 7 000NTRACTOR PHONE: L)Lj S3Q -Y ca by. CONTRACTOR EMAIL: p>G.P/`e f; 6eJ �„r;,aS i-yei 4.n i-Jfr;n'A,0.CCr7o1
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<br /> CONTRACTOR LICENSE#(REQUIRED):,MO 0,&'t}4,j 3L j 0,-,,..J. CITY OF EVERETT BUSINESS IL.ICENSE#(REQUIRED): 0 Li Z MLA t
<br /> PRIMARY CONTACT: ❑OWNER .CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 6.4 Z 5 5 3C✓ -7 Li (0(e,
<br /> Bfzxd 6-)k)4-T5Cie CONTACT EMAIL: A,.t, \ [
<br /> V, ..(..\ �" ijO2
<br /> -1J,--el lv, ItcR",1 Nt:l , cc Y`r•-
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ 5 , L.&. ') 7:1 3
<br /> Proposed Use of Building: Heat Source: Was DElectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ,ommercial Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel2epair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: �t,, S. w.� a rv`�
<br /> jZr,-tev? D%D v.t it i4e Wrtre 01 ; t n:'r►tt C-
<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 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: „mom ii 4C U_ 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 7 City of Everett Official Use Only
<br /> )�— Zi�z� Pririt
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<br /> i er/Author' t Si ature Date (Revised 10/10/2018)
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