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® PERMIT I APPLICATION
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<br /> BUILDING ECHANICAL I PLUMBING I SIGN 10 RINKLER I 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 1"I,Ack,Ct?yv c. -EA/O yfn t► WPt- PROPERTY TAX#: l j'(`c2 /_ '7 0 rs,/'L4`00
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: -.1GI( c.Jt\f' ` . 1\ic- kA , / TENANT BUSINESS NAME
<br /> (Commercial):
<br /> OWNER MAILING ADDRESS: STREET \ MerJ1Ckli c.c l
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<br /> CITY "e'J.e,,F� STATE AI fl ZIP 9. a Z 0 ;.
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: / l'v 1 C.-k")InCT I3ThA/
<br /> CONTRACTOR ADDRESS: STREET ;l w g M'C )1 1 17 i? J
<br /> CITY} E>✓�1� STATE - ZIP �`—' `
<br /> CONTRACTOR PHONE: L[-l_ci 0 \_ 1 c ( 01t�
<br /> CONTRACTOR EMAIL: \J 1 y -{
<br /> c Q in 1 irtn cT+ Ill^t /1 in( ' � iMltn
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<br /> CONTRACTOR LICENSE EQUIRED):r yl I ,SC T .0 1 OK CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3 tg i cj Z
<br /> PRIMARY CONTACT: tELOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: \4`Lc \ Z`(� L{-Y zi-c
<br /> c Ot� 1 . v�rQ/v.l CONTACT EMAIL. �olcv V\/�IV14',v‘V O /c-0r vYl,,,,,,L.C.(%Vy.1
<br /> ( BUILDING INFORMATION
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<br /> Existing Use of Building: S i in< �'tU vnm� i),,z. ,- ..;v gntract Price of Work:$ % 0 1 0\) 0
<br /> Proposed Use of Building: Heat Source: EiGas ❑Electric LJOther
<br /> BUILDING USE: ❑SFR ❑Townhouse ( puplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler CI Demolition EiChange of Use DESCRIPTION OF WORK: O \i 7\--- of l Y.(? v'CR- .° Gf 11 to (-0-y'
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<br /> :,17. ,d,,A,-t-t-f\7/,,, ._1,_ v../K-) A\.)‘ ul L_e__ --k-0 ..A A..e_c_i,__ iv) urrx--- ut4:; ,
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<br /> ASSOCIATED BUILDING PEI4MIT#(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 a_ Gas Piping Backflow Preventer(Inside Bldg) Z Shower,Tub,or Combo
<br /> Boiler Gas Range I Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> I Clothes Dryer Heat Pump&Ductless I Dishwasher 3 Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> 2 Exhaust Fans(Residential) Commercial Ventilatior Floor Drain a_ Toilet
<br /> 1 Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Z 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/InserULog 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 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 /> PERMIT#
<br /> ----, „A\\, ),,,,,,(A,,iOwner/Authorized Agent Signatur L Lt k (Revised 4/15/2019) /, •
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