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II
<br /> PERMIT APPLICATION
<br /> IIIII
<br /> BUILDING I MECHANICAL i PLUMBING/SIGN /SPRINKLER/DEMOLITION
<br /> EVERETT CiTY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASH I NGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black ink Only Please) PROJECT SITE INFORMATION
<br /> 1
<br /> PROJECT SITE ADDRESS: .6n) I'(1 ek,s ( rkjG:: PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: J,%,:'' . i4 AiA_ /VA...f 7 TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET :29 I 1 iff'�'..._ !-iEN rt A Fit
<br /> cm, i.'t'`t "i G.t .., STATE Lii A ZIP le FCC%(
<br /> i'• L e (r 'J' a OWNER EMAIL:
<br /> OWNER PHONE:� �-y'��j," /j r,_ 1 � �<r ti,- (C O
<br /> CONTRACTOR NAME: tr t. e(-42- '" . r::: 1- titi t1 ') Ci,,,
<br /> CONTRACTOR ADDRESS: STREET Z k t j 0 7 4,t E't° .,:
<br /> CITY f k:�;, -` ( STATE kA.,9 ., ZIP ( l
<br /> CONTRACTOR PHONE: 0-1'�S rl ; 2...A A(f `-t CONTRACTOR EMAIL: /6,:•.„kx[ 'C-% -,177,f Lt, ,et a 4 i'''''
<br /> CONTRACTOR LICENSE#(REQUIRED):( V j fZ6, .2se zz.5-r- CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED),C z:)'7
<br /> PRIMARY CONTACT: ❑OWNER Eil CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: (,-I z_c,) +,Cm Ti i 2--2--.
<br /> x .(: ,/\..J , ) r") ,_ ,,, CONTACT EMAIL 1::1, a,-., e, 4 ,`;it t rr c'Gft;.G
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ L Cl > t='_
<br /> Proposed Use of Building: Heat Source: OGas fiElectric CiOther —=-----
<br /> BUILDING USE: ©SFR °Townhouse ❑Duplex DADU ❑Multi-FamI y #Units: °commercial DAccessory Structure
<br /> Type of Project: ©New DAddition DRemodel ©Repair DT.I. °Sign °Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK ._`R,l)i, '(-4, ) 'I..:4 ..t ~; 31.t4 (tc;:.t„a +" :i-.'C I"�% -L4) ')( H E;=Vt r ( (,/4)
<br /> lit,,`1 (,ti.#s“:7,II) v 1, 7 C VI-0t'0...et $...> ' i k(:=il,,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> —
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures count List of Fixtures Count Count of Fixtures Count List of Fixtures
<br /> NC—Air Handling Units Gas Piping Backflow Preventer(inside Bldg) Shower,Tub,or Combo
<br /> Boller 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-Utlitti,laundy,mop,
<br /> Exhaust Fans Residential) Commercial Ventilatior Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not HeatiACystem) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/011 Water Servlee(behind meter)
<br /> I Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Firepiace/InsertiLog 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 heroin 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 f 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 /> /� r ' PE 1
<br /> ?- 1 p r `4. -. 1.. 1(.;I \O \I- D\ 1
<br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018)
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