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PERMIT APPLICATIO III N <br /> BUILDING/MECHANICAL'!PLUMBING/SIGN I SPRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 32©0 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 t(E)everetteps@everettwa.gov I www.everettwa.govlpemtits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2.43Z0 &( / -- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (,"l(? tre4ttA_t 41( `Via t`317 tip NANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET Z ) W`O4y_�j Ai <br /> CITY ti�.1i..K„-i.�7.- STATE WA, zip Qi)' 1 <br /> OWNER PHONE: e i) 2 t- 6,70 i OWNER EMAIL: <br /> CONTRACTOR NAME: C-6IE(-6, 26-y(,, 6f,�.T / rf- . )4(7_, <br /> CONTRACTOR ADDRESS: sinEET '2,I ZO Pit-CI.GZ-,, `t <br /> CITY .—V( iZ-f "rt" STATE Lc)yg-_ zip 11 Y 2 i( <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):LJ /Z s' C7`L"a,t" CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):6 c 7q 5-5 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: iz( c)i c-I) _O 7'IL <br /> &� -11 .w r CONTACT EMAIL: J .ti,ei2 g-5' lL?Q' 'i ( <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ :4 COO• is <br /> Proposed Use of Building: Heat Source: *as ®Electric DOther <br /> BUILDING USE: ©SFR ❑Townhouse ODuplex DADU OMulti-Family-#Units: [. Commeroial ©Accessory Structure <br /> Type of Project: [New DAddition ORemodel ©Repair DT.L OSign ©Sprinkler ODemoiition OChange of Use <br /> DESCRIPTION OF WORK: t <br /> �I-•�S �� .)eta C7h� �©� <br /> IAGt�(2) S5,T/tad <br /> Vie It TN-cOwvv (rn.- Q. ' <br /> ASSOCIATED BUILDING PERMIT#(if applicabieI: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Fixture List of Fixtures Fixture List of Fixtures Flxturs List of Fixtures <br /> Count count Count Count <br /> NC—Air Handling Units Gas Piping Backtlow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3•comp,prep,fioor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain r Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Venhlation 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 `2. Other: ' 1'u `5 Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/InserULog 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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> (21,.%___ cce24 PERM T <br /> it qbil <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) ` <br /> Ii <br />