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".ERMIT APPLICATION
<br /> 12
<br /> BUILDIN i ECHANICAL PLUMBING 1 SIGN RINKLER I DEMOLITION
<br /> EVERETT •F 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: 8 2-U bk) C«5%A O 1Z& PROPERTY TAX#: DG 3 12 I COCA Cc) O 0
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: jive('r c A pea o+r..e L. .1- eioij 13 TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET Z2 Z 3 /i Z 1-L- by r':c S v,rc-- ,0G C7
<br /> CITY /3/(e FLU STATE 't/1,'/A ZIP �7 p QO y
<br /> OWNER PHONE: t/Z 4/5"`/ Zc`i OWNER EMAIL: C iJ12t 7 0 S/lc LT L/Z/t E50 v2CC 5. £O+^-•
<br /> CONTRACTOR NAME: IA/i E2 STATE /ZL 5 7oi-AT/v r-V
<br /> CONTRACTOR ADDRESS: STREET ZZ 3 9 2_ e-,<67-1'` A vi
<br /> CITY 11 1 STATE Vv',4- ZIP yy03-
<br /> CONTRACTOR PHONE: Z 53 23 96 9 T CONTRACTOR EMAIL: L ,3A I h ykr AA; 61'1 Nf EACS7ATC ,ZcS T�%/s'-,47id:
<br /> CONTRACTOR LICENSE#(REQUIRED): ' 3 (, 3‘, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): IrrierrvilO5 -�bt ��"`
<br /> PRIMARY CONTACT: 0 OWNER ErCONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 206 GO(/ 7/i 3
<br /> �etvlc c njc<rki.,...n CONTACT EMAIL: ,I3A g.icv,-.ANC iillfil-EST-IT1= jZ 5TC12-Aric is).c .,`"
<br /> BUILDING INFORMATION
<br /> ExistingUse of Building: 3 1/ S/- /UU t,� /g Contract Price of Work:$ /Co /5-7- /I
<br /> / 1. / //1 /�,�v.(/ ,
<br /> Proposed Use of Building: '' ' Heat Source: ❑Gas DElectric DOther
<br /> BUILDING USE: ❑SFR ❑Townhouse 0 Duplex DADU ErMulti-Family-#Units: .5/-/°° ❑Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition ❑Remodel C' 'Repair ❑T.I. ❑Sign OSprinkler ❑Demolition OChange of Use
<br /> DESCRIPTION OF WORK: Is.} - toor ,. 2 eXhcx,,si n e ,4. j b'-' tat so) per- e£re,-,1- Ir?-,5/ a,� one
<br /> ICA-"Ct✓7 vc-,.i ex,1.r} Pec tnlwv5
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable): v.5a".y rx,51 tij vc•t"t5s•s AQcN POSS Foe y'r26-AIorECrr..D+..
<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) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Z 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: 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 V.27 RCW and 296.200A WAC.
<br /> = City of Everett Official Use Only
<br /> -_ PERMIT#
<br /> .--- i � //F yt, ZcJi4 m (R1( '0Dci
<br /> wner/Authoriz Agent Date (Revised 4/15/2019)
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