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= • PERMIT APPLICATIO4
<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /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: (✓J ( (,v el M4 r e Ave- PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: p_ 0,),,, („/o:ff'Q,. TENANT BUSINESS NAME(Commercial): /l//
<br /> OWNER MAILING ADDRESS: STREET I7/ it 1 el--'olG ,4,/ -
<br /> ff
<br /> CITY L✓e,,fr STATE V/A ZIP 9 X 0)-0/OWNER PHONE: t,, 5 -019.3" 5 5 q OWNER EMAIL: 1/
<br /> CONTRACTOR NAME: J 0r0G n-c+n He-ck'I'INC, ,/(r COQ if'\/
<br /> CONTRACTOR ADDRESS: STREET S( £oL0 tk J''f- ,/l/G✓
<br /> CITY 1�`0-1, (,,r Q STATE 1i ZIP cf /d
<br /> CONTRACTOR PHONE: 3 6 Q •- 6'4,)_ - 3 6 .S 3 CONTRACTOR EMAIL: T3r Q c ,,,,,..„/e. o.fi;n f 6, a,`, co,,,
<br /> CONTRACTOR LICENSE#(REQUIRED). `ri3 ft 0 C Pj (i s S ! e 3 CITY OF EVERETT BUSINESS LICENSE#(REQUI D)
<br /> PRIMARY CONTACT: 0 OWNER ,i CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ,3 6 L)- JSi - 3 3
<br /> rJe-(G'r``r 13 co C.I'- IMG n CONTACT EMAIL: J VrO C k vt_at) k ---ii A 4 . ;?. s--4 i ( , c 0-
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: re T` e,,C , Contract Price of Work:$ -25-00-Q 0
<br /> Proposed Use of Building: Heat Source: pGas DElectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse 0 Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> (was- A.,--A a. ce rep(,-,ce_
<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 /> NC-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 /> 2 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 /> •
<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 /> PERMI
<br /> Owne Authorized Agent Signature Date (Revised 4/15/2019)
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