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grr PERMIT APPLICATIO ' <br /> BUILDIN ECHANICAL / PLUMBING / SIGNRINKLER / 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) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3(I6 S hOrt PzV't Bvere4 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1\•e A PCIV,A 0e— TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 3(0,13 S 11c.W, POI <br /> G CITY Ev eye 4- STATE `,I Li ZIP 0(rL0 3 <br /> �j <br /> OWNER PHONE: -11J -21 1 - �\�, OWNER EMAIL: at -►�0>rll\QV-seyavoO . <br /> cowl <br /> CONTRACTOR NAME: dW Ne rj,. C...oN"' L'1 OCt. <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: XOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: /� CONTACT PHONE: HIS' 2,0 -Z\ I <br /> A-\-eY. CONTACT EMAIL: Ol\e%J_homes a yGq�►O D .COW <br /> BUILDING INFORMATION •J <br /> Ue <br /> Existing Use of Building: Contract Price of Work: $ '70 C�, <br /> Proposed Use of Building: Heat Source: ❑Gas 0Electric ❑Other <br /> BUILDING USE: 1:2:SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler .bemolition ❑Change of Use <br /> DESCRIPTION OF WORK: Devyn0‘i4L. .;VOw} V1005.t c,a i4N,0 CS4V <br /> arc • See <br /> CAt3 avaW;hy. <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 /> City of Everett Official Use Only <br /> ,fr <br /> �� \� PERMIT# w \CI <br /> � 7—,t <br /> 'CO <br /> ^ <br /> Owne 'Prized Agent Signature Date (Revised 10/10/2018) <br />