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moi ak PERMIT APPLICATIO•
<br /> Eli iiii
<br /> BUILDIN(31, MECHANICAL/ PLUMBING / SIGN i aPRINKLER/ DEMOLITION
<br /> EVERETT 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@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 9 2/5.- / /2-0/-/es2 ,9'e/L- PROPERTY TAX#:a9/7 .:9JS/'J % e) 7,90
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> • CONTACT INFORMATION
<br /> OWNER NAME: ge71-/QG L-‘#C_/fir' TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET -?2/5-` �C� � ///%'
<br /> CITY C ve,F__L>-�/ STATE u%1 ZIP `7.c 'Z fly
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: r!�7' T�r/e7 -t�Q- ie" `/ l/c40. fry,,---6,,‹ 7 iY �r0 5, 1
<br /> / p< /�L /) tlfn _ r
<br /> CONTRACTOR ADDRESS: 6 Y6'STREET /Y 9 1 .if.1 /'A /�
<br /> e've�e7 CITY An, ( p� STATEC/ "" ZIP %.2 3'
<br /> CONTRACTOR PHONE:` / -21..—""RACTOR EMAIL: J kA/'\('i p
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSEYE(RE IR D):0%
<br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR iOTHER(Please Specify) /,714�,c"4 `j'' rt'
<br /> CONTACT NAME: CONTACT PHONE: Z. to Z c?"0 . Z 9
<br /> 7,9-7--V*9-- ,9 " y.e` q 4 4���
<br /> CONTACT EMAIL: KS %.C-74, 7'9 00. r0---)j
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: %Q Contract Price of Work:$ 64'/, ' 'c'
<br /> Proposed Use of Building: 5fl2. Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE:)0SFR ❑Townhouse ❑Duplex OADU El Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: CI New ❑Addition ❑Remodel .Q1Repair DTI. DSign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: /j'1 i f �i di ,.9e-/--e'X i7Q j,"cam. / /i,e)i E-i1.‘,..,, ry6z- " .6.9.ii'°
<br /> C I/ 7-/-r e !q,o/r- eAa TLt.c' e, i O s%!dy Le �9cZ. %7 s;t-c.?a' "ee m a r.,i%ri Edge_
<br /> /i 3 6 jet(' .62:,e9,9, , .it&, ic e
<br /> se.' �� es, ��t t� c ' ' Qr©morn. S.W �- '"'
<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 Fixt es
<br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Insida'Bldg) Shower,Tub Combo
<br /> Boiler Gas Range l Clothes Washer Sink;.Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&D ss Dishwasher ,,fink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigerattbn Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) mercial Ventilation Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb y.
<br /> ,- Urinal
<br /> Exhaust Hood(Type II) ✓ Water Heater Interceptor-Grease .�'' Waste/Water Piping Repair
<br /> Exhaust Hood(Reside i ) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air System Other: Medical Gi Water Valves or Fixtures
<br /> Gas Fireplace/ ert/Log Roof rains Water Heater
<br /> SPRINK /SUPPRESSION SYSTEM ewage Ejector or Sump Pump Other:
<br /> Water Suppressio System No.of Heads
<br /> Chemical Sup ession 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 /> City of Everett Official Use Only
<br /> PERM c —0
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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