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(gerr • PERMIT APPLICATION, <br /> BUILDING / MECHANICAL/ 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROD CJ SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 0% //` `�,/,L PROPERTY TAX#: 53-77�7C CV/ 'E7 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 0 C 4 4,, fly 4'S TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 2� ,3 /S/ Sp � ,—. �J <br /> CITY S946--i-1 IA,L'nC9 „STATE (--A-/ ) ZIP 4?& 2 --- <br /> OWNER PHONE: ;6(1 03 ml OWNER EMAIL:A��e( <5i1/`rt�>, �, ;.: &(1y <br /> CONTRACTOR NAME: (7)/.E-'g /5 (fl go C94f fr, <br /> CONTRACTOR ADDRESS: STREET .44,.+-..(;) G,:-5 �%.1$7 VC' <br /> CITY STATE, ZIP <br /> CONTRACTOR PHONE: j Cr C TOR EMAIL: 'LI' PV, O W( 7i I? <br /> CONTRACTOR LICENSE#(REQUI D): 11ie Cg�tsI CITY OF EVERETT BUSINESS LICENSE#(REQUI J: , <br /> PRIMARY CONTACT:Xi-OWNER l HERA(Please`' Specify) <br /> CONTACNAME; L r CONTACT PHONE: 3 6 t, /��j 0 j / y 9 <br /> /l G� �t�! �(�/w CONTACT EMAIL: �l'G�,.— ]s ' -, ..' �� _c/(tr GL <br /> BUILDING INFORMATION <br /> Existing Use of Building: .. --f-'' � Contract Price of Wor $ < 5 r yO,, <br /> Proposed Use of Building: // r-. Heat Source: ❑Ga lectric ❑f her <br /> BUILDING USE: ISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercia F DAccessory Structure <br /> Type fe-ct: ew ❑Addition emodel ❑Repair DTI ❑Sign ❑Sprinkhgr ❑Demoli' n ❑Change of Use <br /> D CR cIQN OF RK: C /e <br /> CK- <br /> ' _ ref <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) 3/..... Shower,Tub,or Combo <br /> Boiler Gas Range ' Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless I SC Dishwasher 3)1... Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration / Drinking Fountain Sink-Utility,laundry,mop <br /> 3 Exhaust Fans(Residential) Commercial Ventilation, Floor Drain 3")4 Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) x 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 Offi ial 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 c m y with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> c(tee( Thiri..7 PERMIT# <br /> /Ai <br /> wner/Authorized Agent Signature D e (Revised 10/10/2018) " ,M <br />