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• PERMIT APPLICATION11112 <br /> • <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 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: &LOC/ k,ki PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME_ E_,t rn t-4:) TENANT BUSINESS NAME(Commercial): ‹.n.tiACC:. <br /> OWNER MAILING ADDRESS: STREET 753e) i,\J 2.-. <br /> CITY \j STATE W1/4)y` " ZIP q ? I <br /> OWNER PHONE: / OWNER EMAIL: <br /> CONTRACTOR NAME: IA e, ve• „t(L i `✓4\ , NCB <br /> CONTRACTOR ADDRESS: STREET <br /> CITY LCx I�_t -5k-t ; {/�S STATE 14,y-/kr- ZIP c-'tE3 v <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): B CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (62 r S <br /> PRIMARY CONTACT: ❑OWNER 2 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,kt ( 7. 3 <br /> k" c rkc' CONTACT EMAIL: C`.r .4; -` <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ "f`-� <br /> Proposed Use of Building: Heat Source: ❑Gas ,Qtl tric ❑Other <br /> BUILDING USE: ❑SF ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: 10Commercial ❑Accessory Structure <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> UI M4i. a r KO MAR cfAir <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 Backfiow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer t 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 Ventilation 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 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 /> PERMIT# <br /> YY1L.PIL' Cebl <br /> Ow /Authorized Agent Signature Date (Revised 10/10/2018) <br /> /2_ <br />