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mil PERMIT APPLICATION
<br /> 1161
<br /> BUILDING I . CHANICAL/ PLUMBING /SIGN / INKLER/ 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: " PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 4 J e-''- A. /< /)' Jac9„ w5 TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET I z02 'H ,q 5 ,
<br /> CITY CV eVreff STATE 14A ZIP / 2,0J
<br /> OWNER PHONE: (L125-) 9/ ' 7:fO3// OWNER EMAIL keil, oni,, 1(Gu;,(0 .._ JocclrOpp
<br /> CONTRACTOR NAME: Rc- (u-I-„/,, PI /,1;61nq
<br /> CONTRACTOR ADDRESS: STREET 6 7 0`f J Gj q 14 PL N t
<br /> CITY " C�y
<br /> / y:5i';/I i Q, STATE 1)4 ZIP 7' 2 7()
<br /> CONTRACTOR PHONE: (L 26) 320. -6 CJ 7 7 CONTRACTOR EMAIL: S <<,i i ale ►V F 5/)I Li,I10,p/ 01 l' ✓o (6144
<br /> CITY OF EVERETT BUSINESS LICENSE#(REQ RED)
<br /> CONTRACTOR LICENSE#(REQUIRED): R�SOL.p �Z,7C�j k.r fr__�
<br /> PRIMARY CONTACT: El OWNER 0 CONTRACTOR 0 OTHER(Please Specify) -Q tlx
<br /> V4---
<br /> CONTACT NAME: CONTACT PHONE: e G 7
<br /> J( I�, (yz�.) 320 6/ 5
<br /> CONTACT EMAIL: 5,f�, e ,E,,50 k o,,,,i ((�,n,1 e ,(Q
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: y. ,f,E Contract Price of Work:$ it-1/00(5r 0 0
<br /> Proposed Use of Building: Heat Source: ❑Gas El Electric ❑Other
<br /> BUILDING USE: ElfSFR ❑Townhouse CI Duplex DADU El Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition ffRem1l odel ❑Repair
<br /> / ❑T.I. ❑Sign ❑Sprinkler r ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: Rat `(C,nq AO Ora, i An 4c 4 v ei'r S L. l-roLo e A nel 14( re v L IB e ad- ro
<br /> I//\; €,if-- f
<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) 1 Shower,Tub,or Combo t
<br /> Boiler Gas Range l' Clothes Washer ' 'Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer _Heat Pump&Ductless j Dishwasher I Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) _Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain I Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) 2 Hose Bibb - i=Llrinal
<br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil I Water Service(behind meter)
<br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains j 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 1 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 verett Official Use Only
<br /> ,✓ PEFtVIIT ` A 023
<br /> .-----'--?Owner/Authorized A nt Signature Ddte 71 (Revised 4/15/2019)
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