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<br /> Imi PERMIT APPLICATION
<br /> Ill
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/ DEMOLITION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINOTON (P)425-257-8810 ) FAX 425-257-8857 ((E)everetteps@everettwa.gov I oww.everettwa.govtpermita
<br /> Mao or Black Inc Only Piave) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: \L--tl--4- \OO I' j\d �N)}r )A PROPERTY TAX#: 0QL-t ' '... tc. - "17-3-
<br /> LEGAL for new construction Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 07.1- Fie E` -0 '..i U ., TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: srnesr 1.0- r, LL\`� \I \CI ke } i-i rt "'m5 * l-ok
<br /> CITY wC 3 c \{�J l\ STATE • 20
<br /> OWNER PHONE: ` toIt,-t .C,c f..y - ` 171 OWNER EMAIL: ,V10,(tOr)- ti , Tc,�J1i , 60,A"
<br /> CONTRACTOR NAME: 6iC,:yV.An y,p.,e-r\ e\"4-r iot--
<br /> CONTRACTOR ADDRESS: STREET Rt Q a.47 "",:,.�\ �ry j�
<br /> CnY if1�,J. a,A `e\\.0 STATE \J ZIP % ' !j
<br /> '7,
<br /> CONTRACTOR PHONE: "j,,t. t'\. t.\--4.1\ CONTRACTOR EMAIL: ad"wsrAt n49 c,•\1 1,,, ,
<br /> CONTRACTOR LICENSE#(REQUIRED): (Z`7AN
<br /> 4. Ol,zj© ;?C. 'CITY OF EVERETT BUSINESS ucENSE uIR>_ctuIRm): I-{A `t"1-
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 13413TFIER(Please Specify) PIT-kAi- C)
<br /> CONTACT NAME: CONTACT PHONE: ,.l.- r , r-)..-- s * \... n
<br /> .-\`\c Q Ct) CONTACT EMAIL: i ' ;i7t1\'lN , t" �`-„iv
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Wor :$ 6 -3 , 1,4 ,------"---6/ gs(y Q`D
<br /> Proposed Use of Building: U.nG�c�A 1�c7 2 Heat Source: ❑GASP, DElectric DOther ( J
<br /> BUILDING USE: OSFR OTownhouse DDupiex DADU DMulti-Family-#Units: \. _ DCornmerclal _DAccesso Structure
<br /> Type of Project :New DAddition DRetnodel DRepair OT.I. ❑Sign DSprinkler molition DChange of U _,____-----
<br /> DESCRIPTION OF WORK: c l
<br /> ASSOCIATED BUILDING PERMIT#(if applicable: f -`x�' ' O-1,9
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture List of Fixtures t° List of Fixtures Fixture List of Fixtures Fixture
<br /> Count
<br /> count Count Count List of Fixtures
<br /> A/C—Air Hwang Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(9-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ducttess Dishwasher Sink-Residential(kitchen,bath.bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utitty,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilator Floor Drain Toilet
<br /> Exhaust I bad(Type I) (Not HeaLiAC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease WasteMlater 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 Factures
<br /> _Gas Fireplace/Insert/Log Roof Drains W ter Heater
<br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Otter:
<br /> Water suppression System t•fo,of Heads
<br /> Chemical Suppression System 'Flo.of Leads
<br /> ACKNOWLEDGEMENT!have ravrewed this application and confirm the information contained herein is hue and correct Work done pursuant to bits peril must campy with
<br /> cunent federal,state,and local law The granting of a permit ordy authorizes approved wok and no deviations therefrom.Deviations must rust be authorized in wntmg from the
<br /> Budding Official before being auth d under any cacumstance lam the owner or!am authorized by the owner of this property to perhum the work for which appiicafan is made,
<br /> and I comply Willi Law 18 27 RCW and 296 200A WAC
<br /> City of Everett Official Use Only
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<br /> t� ZC� PE ,lip 7CX) —C
<br /> Owner/Authorized Age Signature Da (Rev' (I2018)
<br /> E/Z___
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