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= 0 PERMIT APPLICATI•
<br /> 12
<br /> BUILDING / MECHANICAL I 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: /3/S P,r c .• C A Ii',— PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> / 1 CONTACT INFORMATION
<br /> OWNER NAME: C L P1 )-^k4 L P TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET e llC_ F X e L LA. y,Lc 8 J', 1 j 're c O V
<br /> CITY S (-4 I r e,- , STATE " ZIP /C / d
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: L k.-v C /%r t k-,or ,2i-e3 /
<br /> CONTRACTOR ADDRESS: STREET ;y4 F /E
<br /> _ p >.-'- 'to n
<br /> CITY Y.-It fr .Vti� STATE ✓v \' ZIP % 9 U/
<br /> CONTRACTOR PHONE: 31, c 3 v7-b i/3 Cr CONTRACTOR EMAIL: L€ E t/ ',-c .� „,
<br /> CONTRACTOR LICENSE#(REQUIRED): L1('1c F.:_ Se, T✓ CITY OF EVERETT BUSINESS LICENSE#(REQUI )
<br /> PRIMARY CONTACT: 0 OWNER 7-CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 3 G.t :S D 7 L v..t 6
<br /> Lie C ✓-,,rl-�- CONTACT EMAIL: t-e e L/c.,riC F y7/e,-/i- :Se>, e.,„
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ C, L' r
<br /> Proposed Use of Building:f.}.,(.-s) f,4,.. I--, 4 /a„A) e. Heat Source: ❑Gas Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑M,ulti-Family-#Units: 126mmercial ❑Accessory Structure
<br /> ECJ
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: 1 /� ,N r II.,,, S.,►I/C
<br /> Nitir l a<- , ,,,, C`, .tiiii,ti5 1`�;,.,fi+ ,,,
<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 Z Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration I , Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 1 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 . .2 Water Heater Ps.h y o f ,.+Se
<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.1 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 /> PERM #
<br /> ,2—I e")—e U01.--CO 5
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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