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= PERMIT APPLICATIO
<br /> BUILDINPECHANICAL/ PLUMBING / SIGN , PRINKLER/ 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: ,._?66 861, (yi i C Y Alit Tveic-ti-L04 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: /4 tr,h l S h i 1 A[0 TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 3.� f S I 't Pi. 'w
<br /> CITY�1a 1wor0d STATE ZIP
<br /> c� GJ ` t �^
<br /> `? t,, g —(` / CI, OWNER EMAIL JOic / Sly 117E ll�l91 i,`�'l0 i /"( .6n4'`l
<br /> OWNER PHONE: ,J �G- '
<br /> CONTRACTOR NAME: /?(jmY'.5 6i,0 -71,) ,'�.-lj r )/
<br /> CONTRACTOR ADDRESS: STREET S p.,�Yl - 67 a ;ic'J 6
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: .1i,ti - ? ? '- / l j 7 CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED) ' �/Ie ,L �c C N �� A j. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):,4
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:/ CONTACT PHONE: ? j 30 3-- lq 161�/
<br /> 1 11/1 dt t( gil {+'/D CONTACT EMAIL: I1 I di�'I CI.5vl i 16 6_) ilvu l „ con
<br /> ,8'Ian
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: �M,s jr- r�,,,�;j y Contract Price of Work:$ ?>d)C
<br /> Proposed Use of Building: 5,ji, Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ,' FR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units:_ DCommercial ❑Accessory Structure
<br /> Type of Project: ONew ❑Addition NRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use
<br /> DESCRIPTION OF WORK: I/t I
<br /> 1nslail hem riirvre5 ,N- ✓ �,tL. /, de) ivr ,A�,S fii fi5
<br /> of,,,,1„,55 A, „/ to0441 (re,n . 24al /az k Porch6-; Go-' (o j7a-7' k)
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): r ��pc,_ v P� 1\
<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) ,2 Shower,Tub,or Combo
<br /> y Boiler Gas Range 1 Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> 2 Clothes Dryer Heat Pump&Ductless L Dishwasher 5 Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> 14 Exhaust Fans(Residential) Commercial Ventilation Floor Drain 11' 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 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 /> PERmkg,b9),....... 00
<br /> k
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
<br /> 2
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