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PERMIT APPLICATION
<br /> kE , BUILDING IIIIPECHANICAL/PLUMBING/SIGN/ILINKLER/DEMOLITION
<br /> 1/E R E T T 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@everedwa.gov I vAvw.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please)` PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: Z 6 `Z I 0 iv) b cAr- c/v1/t— PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: E.re-c. P t U,ryt.evv-e — TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: s-mcEr 1 (a1 L o,M.1, c v
<br /> cnY E J J_r e- - STATE ZIP pj ® 1
<br /> OWNER PHONE: 514\ *^2%3 — I o 01 LIt OWNER EMAIL: G.e~,.vt 4 L wY I a' e-A g C" ®''vt
<br /> 1.CONTRACTOR NAME: G_ _ .._-_- — - i L - -
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: - _ - _ 'CONTRACTOR EMAIL: M _ _
<br /> _ :J" - —
<br /> -
<br /> CONTRACTOR LICENSE#(REQUIRED): - _ - .. _ :try OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 541 " Z t 3 — I 0 at 11
<br /> Et"t p C i i u + v' CONTACT EMAIL: .,S,�,1 n 0 w y 1 t,� 9 Q . C,o.�
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: (2o l r,L1 .e Contract Price of Work:$r 3,500 • ©0
<br /> Proposed Use of Building:Vi:ry 5,vw,,\I /l b-n u/h brhe, &rtwery Heat Source: OGas DElectric DOther _
<br /> BUILDING USE: IJSFR ❑Townhouse ❑Duplex ❑ADU ❑Mu Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> AA a.i„� F tact d.ram:n f-o 5 o,.rk,9 e . AAA.,Ai 5' w 4-4-cr- r.xi-v r-e5
<br /> lose.. tJc" _o w A ✓ -j-r,4= p r t rA tr ,, J4l.A i, Si-ti tr(, Pb-"t- F:11 , A 1 `n 3 ••vcs,s l
<br /> 'e..-X k J �6
<br /> 5 k ,/t ,. I n )4-6,,i1 o A., 5 rn rs t% vV(n. or in e.G.A-e.-rr co r h 0' is1/k
<br /> L+h ey 4 n i .S U p
<br /> ► I-1=PT,--
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fortune List of Fixtn�es1N° List of Fixtures Fixture List of Fixtures Ffxtuuo list of Fixtures
<br /> count Caro Count Count
<br /> NC—Air Handling Units Gas Piping Baddlow 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 j Sink-Residential(kitchen,battr,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Mk,laundry,mop
<br /> j Exhaust Fans(Residential) Commercial Ventilatior I 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 5 Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains t Water Heater
<br /> SPRINKLER I 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.lam the owner,or l 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 /> PERMIT#/ '� I �r O O
<br /> Owner/Arttf�orizsd �te (Revised 10/102018)
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