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PERMIT APPLICATION
<br /> in 4110
<br /> BUILDING / MECHANICAL/ PLUMBING I SIGN I 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: c S ZD /P;r-gr• .e,;ti_ l iic•-� i 1 red-,IA.ROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision ) Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: I.47 p,p Evc,-,n TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 29,3o (n/ekir,,., Qvc A l/^E
<br /> CITY a' Ev,,m L STATE r/(//i ZIP r 62ol
<br /> OWNER PHONE: 923- . 4 29 51 OWNER EMAIL: rv,1e,70,eive,„,9x,u,rev
<br /> CONTRACTOR NAME: _Eli ,U.rf H1,t t IL — QU.r- a•.. ( e s�LA-1b�.. T,.te�_
<br /> CONTRACTOR ADDRESS: STREET I /QO 0jK7 0f t Ur
<br /> CITY ...-r-of Ls;I STATE LC A ZIP Cr x I Q f+
<br /> CONTRACTOR PHONE: Z d(o _ .S-73 - e g 2..6 CONTRACTOR EMAIL: e.6c4n10,1nn;1.,,42ln�v4aH 4.00,s'Fru6.4-;„,... •vvi-i-
<br /> CONTRACTOR LICENSE#(REQUIRED): Q U r r OCG% D3(blM 2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 4 >� /9)'J1
<br /> PRIMARY CONTACT: Ia OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 9:2.1 328 YSS-7
<br /> Ji vNt,7 CONTACT EMAIL: ihnt./Q et/ere ..,,.a 7,1v
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: /'r:r Dep4,/-raven4 Contract Price of Work:$ esx
<br /> Proposed Use of Building: F1'rr b ocu-F,end- Heat Source: NGas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU El Multi-Family-#Units: E1Commercial ❑Accessory Structure
<br /> Type of Project: ❑New DAddition ®Remodel El Repair ❑T.l. ❑Sign ISSprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> Reend4 L? vam, per. ph"i
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture i
<br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures..
<br /> Count Count Count Count ..r-"
<br /> A/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) 5 Shower,Tub,oi,Cbmbo
<br /> Boiler Gas Rang./ Clothes Washer Sink-Co ipi cial(3-comp,prep,floor)
<br /> Clothes Dryer He ump&Ductless Dishwasher 3 Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) z] efrigeration Drinking Fountain -Utility,laundry,mop
<br /> Exhaust Fans(Residential) ' Commercial Ventilatior\ Floor Drain jam' Toilet
<br /> Exhaust Hood(Type I) ,!-' (Not Heat/AC system) Hose Bibb ,-'2. Urinal
<br /> Exhaust Hood(Typo f() 4. 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 Fir lace/Insert/Log Roof Drains i Water Heater
<br /> SP KLER I SUPPRESSION SYSTEM', Sewage E' for or Sump Pump Other:
<br /> Water Suppression System 2, 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!comply . the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> �� I7z )/a.C7� ^ o
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) 1/1
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