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an ill 1110
<br /> PERMIT APPLICATION
<br /> NI
<br /> BUILDING I MECHANICAL/ PLUMBING I SIGN i SPRINKLER I DEMOLITION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 426-257-8857 I(E)everetteps©everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: '2.6 3( l t T ir)a2e //tics (PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME:
<br /> l C>pkiloy '#NV O(7C.47"-Lodi/CS TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 7(00 J ZC42 C=r~N Z,ft?y cS'- - r C= At /r7
<br /> CITY L 1J1< ITT STATE (,�,7'{� , ZIP Qrs o_3
<br /> OWNER PHONE: Sap 55g - Z54-5 OWNER EMAIL: 3'904'/7 Q W p l-i Nt2, b i Z.--
<br /> CONTRACTOR NAME: t/CaZG,IzL--,5'-6i-r}E /T14r 4L Ad.,
<br /> CONTRACTOR ADDRESS: sTREEr .7�---tZ.)e 1�ir�CJA: ^�,�,
<br /> CITY Y FT- STATE - ZIP CigG.i,.+i
<br /> CONTRACTOR PHONE:(Ltzt) Zc` '//Y- CONTRACTOR EMAIL: /<4.4..4-a-55✓t.Wu..,L pyh
<br /> CONTRACTOR LICENSE tt(REQUIRED):tr-,I.W.6 c502Z vr CITY OF EVERETT BUSINESS LICENSE tt(REQUIRED):S l79,5 '-
<br /> PRIMARY CONTACT: 0 OWNER ' `CONTRACTOR El OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:(!,(-Z -) ,51 f _ 6.72z_
<br /> K(...-_,-2,.) /4-c. ) CONTACT EMAIL: 1-2,e-vl, ucva. cM
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$__Lid 99 t• 0--
<br /> Proposed Use of Building: Heat Source: ( Gas XffElectric ©Other
<br /> BUILDING USE: ©SFR °Townhouse °Duplex OADU °Multi-Family-#Units: PaCommercial °Accessory Structure
<br /> Type of Project: °New °Addition ❑Remodel ©Repair DTI. °Sign ❑Sprinkler ❑Demolition °Change of Use
<br /> DESCRIPTION OF WORK: 12,e p(at;1L 3 Tt 5 p(;.E-. 5,y1-.c. ,L I.,E -1- y� 4c.i/ ,uC-Tc�,,,, l ,5
<br /> y5 -, a�-T C>vit- Ws. et iS (6}t „*T ( �r i
<br /> ASSOCIATED BUILDING PERMIT# if a+•licabie :
<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 /> j 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,tloor)
<br /> Clothes Dryer j 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 HeaUAC system) Hose Bibb Urinal
<br /> Exhaust Hood(Typo II) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Afr 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 1 No.of Heads
<br /> ACKNOWLEDGEMENT:(have reviewed this application and confirm the information contained herein is live 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.lam the owner,or l am authorized by the owner of this property to perform the work for which application is made,
<br /> and f comply with the State Contractors Law 18:27 RCW and 298.200A WAC.
<br /> City of Everett Official Use Only
<br /> 12‘,.._t____, PERM
<br /> /Z Z / ����
<br /> �,
<br /> Owner/Authorized Agent Sign ure Date (Revised 10/10/2018)
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