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<br /> III PERMIT APPLICATION
<br /> BUILDING/MECHANICAL I PLUMBING I SIGN I 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)everettepstmeverettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SiTE ADDRESS: 'Lei i t t i( i.t.it:" '" „1t-.Ii 'PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ,it--L<.•) r':I.. i`t Dt;i TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET - ,
<br /> ...
<br /> ic 4 11
<br /> CITY t it It. tr STATE !,.`..>4 ZIP '(1 ZL.`‘
<br /> OWNER PHONE: (L.1- 1 7 >,4%'- i,-.4 ' OWNER EMAIL: k44-
<br /> CONTRACTOR NAME: f`:-t't (zki"2 L-9,a:/t_, :4"yt•7-4-7:, /r/"' `l 1.,.¶ /1(
<br /> CONTRACTOR ADDRESS: STREET 4.1.'=Z:` 4 44.-Cl.c..,
<br /> CITY (.. ,'is .jc gr r._..,.. STATE (.,L4I4 ZIP (1 ' I t.')
<br /> CONTRACTOR PHONE:(T-t Z e r 1 i( CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): G•7ZZ:.3 4a"i e' 4, e--1`"" CITY OF EVERETT BUSINESS LiCENSE#(RE(,IUIRED): vi DWI( .}5
<br /> PRIMARY CONTACT: ❑OWNER 1 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME CONTACT PHONE: ( Zesa �, - 1;7 7
<br /> I(- C ri .�,.' CONTACT EMAIL: 1c! 1,4 e,'` 1',,a j/ii 9 4i,•s%f,el Cr.'4.4
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$`can,
<br /> Proposed Use of Building: Heat Source: ❑Gas tdElectric ©Other
<br /> BUILDING USE: CSFR [Townhouse ❑Duplex ©ADU DMulti-Family-#Units: l ,Commerciai [Accessory Structure
<br /> Type of Project: [New DAddition ❑Remodel DRepair DT.I. [Sign [Sprinkler DDemolitlon DChange of Use
<br /> DESCRIPTION OF WORK: t,,,- 114.k-L, 7.n.. r5" >i-..'_ (: t.4(--r)4;'I,, I.f c,fi'r" �° ) \/ .I
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<br /> t kF ,-)-. I-.4 I,t,.(;) (,frsi i ? ItAc, iL ni. .} n1..) ;c, i � a ;
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> ,
<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 Backllow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,iloor)
<br /> Clothes Dryer I 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 Ventilatlor Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type I1) Water Heater Interceptor-Grease WasteM/ater 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 Water Heater
<br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Elector or Sump Pump Other:
<br /> Water Suppression System No.of Beads
<br /> Chemical Suppression System I 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,slate,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 lam authorized by the owner of this properly to perform the work for which application is made,
<br /> and l comply with the State Contractors Law 18.27 RCW and 286.200A WAC.
<br /> 1 / City of Everett Of icio/Use Only
<br /> I / /
<br /> PERMIT#
<br /> Owner/Authorized/Agent Signature Date (Revised 10/10/2016)
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