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<br /> PERMIT APPLICATIO
<br /> BUILDING ECHANICAL/ PLUMBING /SIGN RINKLER/ 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: 110(.0 7 Pet,,,,, F; eI,;{ ()Lo Cvci,eff,9g2.OiPROPERTY TAX#: 00 �7�.©©r oO 7OC�
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: l.�;„a,v� uy►„.0 . ,
<br /> ` TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREETf p�++40�6 3 9 S i L((p�►l,Str
<br /> CITY X S Sot c U Ck I STATE LA/14 ZIP g g 6 2. 7
<br /> OWNER PHONE: 2.0 b - Co (09- 21(69 OWNER EMAIL: t viN.l,n;,, 0 9 yv‘41,1, 60
<br /> CONTRACTOR NAME: �"" ✓J
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: aeOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2,06 G G 9- 21 C.9
<br /> 0_, ,,1 U , J , CONTACT EMAIL: -t-.k� , y tin I. L e
<br /> ii i. 'CVO-
<br /> INFORMATION J
<br /> Existing Use of Building:S ;,..y I.e., FTA.;i g.6'_5;ct,EV%c Contract Price of Work:$ `"'`'
<br /> Proposed Use of Building: S ;Al /.. Fol,,v.1 lags;,(2,..„_ Heat Source: Q7Gas DElectric ❑Other
<br /> BUILDING USE: �FR ❑Townhouse ❑Duplcyk ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel tepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OJF WORK:pe d„:, 1 0} Un e_e NI,f` c( l.,+er;c,- rvc.Ij -, e.1ecf✓tc,( g.wa4. ior„'"b:,--i
<br /> 4& 1o...4.r' IR.re..1. I set of draw i�nqs S/iGwi awe n+ Sfa . Z'Ld 5 t Cs ye,,N-' . ke�W1
<br /> re-vres4cd .9jai<, Apt it, C-0(/ 0. Z v„abler tb f;Ndt 5o WV?V"- :,4.tTI; * cA a,w 44 -f-0,- r -
<br /> e.a.5c it.GE.2©-o HS"S 11550C, i et per w+:ts c.2oa7-oo5- r 4P2067-o01-1_
<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 I 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> Cl'v -112t�i L PERMIT#v lb � � J r r '> j-,
<br /> Owner/Authorized A ent Sig to Date (Revised 1-0/10/2018) I
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