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0 PERMIT APPLICATION• <br /> lali <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASH I N GTON (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 /> PROJECT SITE ADDRESS: 14 D I fs of b r oo k M4• PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: N1610 S harm ell, TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 01 .f4 0(b(0O {�1e <br /> CITY yef STATE krj Pr ZIP 1 03 <br /> OWNER PHONE: 1925) 311s- IZ(.01 OWNER EMAIL: 110/10,d5 1, /0(ma(I . aryl <br /> CONTRACTOR NAME: 13 ei a i y N W <br /> CONTRACTOR ADDRESS: STREET 124 21, Ow J D( Ti Jr'CITY CITY e V e C STATE (A)Pr 1 ZIP 1 K2.01 <br /> CONTRACTOR PHONE: (jp(p) ?lg.- ,I' 9 3 CONTRACTOR EMAIL: be r'u O"t-c l(Q 1 a7.ninr t I .( 0(Yj <br /> CONTRACTOR LICENSE#(REQUIRED): RffeAdcT(sc. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(o01Lo U <br /> PRIMARY CONTACT: ❑OWNER ,CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: 9V l bran dot D 1 rtCtp CONTACT PHONE: (lb(p/7 9 g -' 571 3 <br /> 3e e2f-alt r tw CONTACT EMAIL: 0einWo-R.jc,e,.1r gmal ( . (arn <br /> BUILDING INFORMATION 1 <br /> Existing Use of Building:S(nq[2 r(AN11111 YVi , Contract Price of Work: $ -S C) <br /> l'rf,1 Proposed Use of Building: S Lk"(,),(/Vl( IA EV Heat Source: . as DElectric DOther <br /> BUILDING USE:1SFR ❑Townhouse ❑JDuplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: New lgAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> n&a Amf(«-ci 1, S-i v\ei A.(e{ 5''0% 214-1'(r k P"ill S 1162 S411.11,-1Arv1 G i ew <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 Ventilatior 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 /> (�j d <br /> (CiGty off'E�veere�tt Official Use OnnllyQ�1 \ 1 PERMIT ` \lJ \ " U \ (�s ,�fY 1` <br /> Owne Auth i ed Agent Signature ate (Revised 10/10/2018) <br />