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PERMIT APPLICATION <br /> ® ;I UILDING I MECHANICAL I PLUMBING /SIGN I SPRINKLER/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: �‘Cj E' CA(el.b Dr Ct 4- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �� �,�CONTACT INFORMATION <br /> OWNER NAME:V i(1 tw t. Pry P i`�''"'ifelWi' TENANT BUSINESS NAME(Commercial):kiQlei(ik cot fe, 1 f <br /> OWNER MAILING ADDRESS: STREET 3 ,s- E (0/g I n v a_G( e-f-c A- <br /> CITY Fve/re STATE VVW zip 1$74) <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Eu 6z(.�j.," , -4-r e' P64L <br /> CONTRACTOR ADDRESS: STREET 2J ZO7�P/�-C-t�4C C_ <br /> + <br /> CITY .V(.'/�C..lr STATE UJAr! ZIP Ci4 t <br /> CONTRACTOR PHONE: f-i Zc) 2sZ-3/(`-{- CONTRACTOR EMAIL: �j(1 a Yt SSe @ as Irn(IvQ ,COYVN <br /> CONTRACTOR LICENSE#(REQUIRED): jV 502-Zcr CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):00 19 S S <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (Liz 5', •_cY7 Z., <br /> th XVI S se...G Vt evi els CONTACT EMAIL: Chan(SSA Gg$m%/JcZ ,Lows <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ "J J55 <br /> Proposed Use of Building: Heat Source: Was ®Electric DOther <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ligkonnercial ❑Accessory Structure <br /> Type of Project: [New ❑Addition ❑Remodel ❑Repair r -.I. ❑Sign :Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OP WORK: ivei <br /> ( „n f c� / 0 / ,� owls, -j c., 1`�,Q 27--. wr <br /> IJ�J c� 0 ti^" " <br /> has h604 U <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 <br /> a <br /> List of Fixtures <br /> NC—Air Handling Units i 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 fj Other:VIA} IV(}PN . 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 ern the owner,or lam 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 /> ^� �J '., City of Everett Official Use Only <br /> M C�� �ra J 12-.!1 z0 PERK c� 05� <br /> 0 r/Authorized Agent SIgna ure Date (Revised 10/10/2018) <br />