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PERMIT APPLICATIO
<br /> MI
<br /> BUILDINGGIECHANICAL/ PLUMBING / SIGN RINKLER / 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) 1 PROJECT SITE INFORMATION (7 ZG i'
<br /> PROJECT SITE ADDRESS: 2'/CO G 1' " 6/ 3 7 v9. ��/ y,„11( 1ROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: /-1d, 0, c d 1 11 / ygr r y,, TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET �s d ecs ,.,jam..7 14_ �/ 41(.1 (�Q
<br /> CITY t�0 it e (/ eN, „c" STATE l,/I.�A ZIP a , T
<br /> OWNER PHONE: ,/2 c - 9.c f-- 3 ,2,C OWNER EMAIL: ,,ei i cA&(4h, 9 c e ^�' c, QQ I I_ c (7,
<br /> CONTRACTOR NAME: 7 Qf/J1ACt
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: $OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: C f x S ,_ 1�Q j- -z 5 .2 C
<br /> / I
<br /> $��' C LI I R�(��l CONTACT EMAIL:)'h.G Y f ( t-� C 7�� ®1 IAA.,c,,_
<br /> l l,r a^ ,.
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ �, 06 0
<br /> Proposed Use of Building: Heat Source: ❑Gas Electric ❑Other _._
<br /> BUILDING USE:2FR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition IA2emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: remodel with a second story addition, Including-new plumbing,electrical, foundation
<br /> modification,roofing, siding, decks, drywall, insulation, cabinets, flooring, doors and trim,and
<br /> .paint
<br /> •
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): I .. cam . %vL �i-�_--- yy A f Vs.A3( \V'X>
<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) 3 Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless 1 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 2. 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 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 /> !; I J - J 7— 42r)
<br /> Z� PER # -0c \
<br /> Owner/Authorized Agent Signature Date (Revised 0/10/2018)
<br /> 2� o2- oN '�c
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