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= • PERMIT APPLICATION* <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / RINKLER/ 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: ;� 3,� -\\a 5� A.) et fz ,y -4 1__i_. TCfp <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach c f long legal description) <br /> CONTACT INFORMATION OWNER NAME: Cr-) S..)�.c( by L,J� \ vas -- „.,_A TENANT TENANT BUSINESS NAME(Commercial): 33 CObr c:vl( Np 1, <br /> OWNER MAILING ADDRESS: STREET \\Uv � . \ cAr S. \ ZDo Y'\e��,->.r-4 r,acL (4. qj VG,0 <br /> CITY V\Q L.-, yY k I,e C, C,6 STATE C. ZIP qa(T(F 0 <br /> OWNER PHONE r}<, " 3t-1 �� (J 1,v� OWNER EMAIL: W Ij tP 1.Vic_ 6,r-\C, c C us-- <br /> CONTRACTOR NAME: V>r cG r—S(/:,e{ us) L L c. <br /> CONTRACTOR ADDRESS: STREET \1 c,"� '71'4- .0 c 01 I c <br /> CITY �, V-P y-L--- / STATE kJ 5 ZIP A <br /> (f) ! (�� <br /> CONTRACTOR PHONE: <<)-�- 1 O - '�{ CONTRACTOR EMAIL:&J�' -4-Co f[ /t ' <br /> ,V <br /> CONTRACTOR LICENSE#(REQU ED): � v(-U -1) SZ( ^ CITY OF EVERETT BUSINESS LICENSE#(REQUI D):(�Gy,( 1 cS <br /> PRIMARY CONTACT: 0 OWNER ER(Please Specify) 1 rP `��c^ <br /> CONTACT NAME: CONTACT PHONE: L{..).i - 3q V - (-1(1t7v - Y J\ 3 - 5)V ) <br /> \(����J. �� `\k CONTACT EMAIL: 1 <br /> BUILDING INFORMATION <br /> Existing Use of Building: \1Q 5 Contract Price of Work:$ (ti;J 'IC)`„ <br /> Proposed Use of Building: 'N Heat Source: OGas b ectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU I Aulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. OSign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <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 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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> .7/ itci <br /> 7//� P k <br /> ng 0 .11 <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) `,2 <br />