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PERMIT APPLICATION
<br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (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: 1 Qro se gore}moll Idly Eictte)! PROPERTY TAX#:„zc p'O)g' 3D(pbO)
<br /> LEGAL for new construction: Short Plat/subdivision J Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME:`4(`'4 It Jet o e k,t, 1)1c L L—t_, TENANT BUSINESS NAME(Commercial): �,e1/�j'6 ,
<br /> /f�,OWNER MAILING ADDRESS: STREET ' �,� b i P h(`z,
<br /> cITY S✓101 o 101 S� STATE (A9k zIP 4() O—(74z.
<br /> OWNER PHONE: .O(O— (I' ' — CO YCL(1 OWNER EMAIL: t"‘ jell Fy 7l'il f Le)/ 3if-C -co iil
<br /> CONTRACTOR NAME: G. / /
<br /> _ (( I r ,{
<br /> CONTRACTOR ADDRESS: STREET /S D 1 g©n✓1 e Vr(/ 16 e_ A u / �r1S t,- , —L A—
<br /> CITY S ('L C�k(a(/�( S STATE Ili /-h ZIP C2 9 Q
<br /> CONTRACTOR PHONE:3 (90—t 7. l9 7(25 CONTRACTOR EMAIL: h h to cJJJJN p c pm Al,.^,(^IV
<br /> CONTRACTOR LICENSE#(REQUIRED):C.0 M.M,at_e.Co).., I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):271 leC
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 14 2b ,5 &3 sc9,Sq
<br /> /-iGL` 1 ,e, U CONTACT EMAIL: i b e..—...coil g., G 1,AAA/49.(I) ,'jv
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: © `z GP, Contract Price of Work:$l', 3 77,,E 60v CO ]��
<br /> Proposed Use of Building: Ot I`G e_ Heat Source: ,MGas ❑Electric O.Other i ,AlC/" St_vs r.,
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: commercial ❑Accessory Structure
<br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair AT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DES 4,e WON O OF2�(R c t 11i V—t d t S 1 Fy WIN,I, 4 ,L S J y t GJ O -c.-sr G'e___ G PG4..L.'e__
<br /> 1 to uL Gt,`vk 1 N,pc co‹ vv-,Gulf
<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 /> NC—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 /> 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 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 /> 7‘ ekli
<br /> 3/9. 1//1PERMI (g� f OLOwner/Authorized Agent Signature ate (Revised 1010/2018)if
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