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• <br /> PERMIT APPLICATION <br /> UILDING/MECHANIC/z L/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ®r Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: f S -O (41 1k i"10 12.70 rtr t {wk PROPERTY TAX#: 00Q2- <br /> LEGAL for new construction: Short Plat/subdivision C0--+0 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6-14. s4J`°) P'P s 5 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 310 1V'e i 9} . 5 J IDa <br /> CITY /9 i I STATE 1 e l) ziP (]S J <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: C-7 i T 1 L "TT(— C ? i(2-U UI I bVV <br /> CONTRACTOR ADDRESS: STREET I }Lt 2 e P L` '� . <br /> CITY 11 b T(� STATE ice! i ZIP q 8 0/ <br /> CONTRACTOR PHONE: H2 J ti q " S b D i CONTRACTOR EMAIL: 14 L(4e21.141-it'-/JA.'d 64-iTucCt`r`lJ.i 1-V" y _ c i47 <br /> CONTRACTOR LICENSE#(REQUIRED): ){� / S 6 Be i t i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): - C'3 <br /> PRIMARY CONTACT: 'DOWNER ',CONTRACTOR 0 OTHER(Please Specify) /O <br /> CONTACT NAME: CONTACT PHONE: L(25- `t 1 6 $'1 <br /> 00v CONTACT EMAIL: 2J}Gwe C? 14' -.s611rT-GUwSTt_ucttoly. COiti <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of ork:$ 2/1 ?,1,V,"' <br /> Proposed Use of Building: Heat Source: ❑Gas eetrie —Ge <br /> BUILDING USE: ❑SFR OTownhouse El Duplex ❑ADU f lt\?ulti-Family-#Units: 7-06 ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New OAddition ❑Remodel IPRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Lo W�i'c, Li. f !if_,F p-j-r r Ll,p °) • <br /> � 3 <br /> Tic J , tLi� 3 I?--e-A9L J a Aft iv i r , 12- l e; , (.5 D t ;PI 6 Oct <br /> O u p U � r► • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Fixture Fixture Fixture <br /> Count Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—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 au nze under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State ntractor Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Q PERK® e <br /> Owner/Authorized gent Signature Date (RevisecY 10/10/2018) <br />