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PERMIT APPLICATION • <br /> BUILDING I MECHANICAL I PLUMBING /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)everetteps@everettwa,gov 1 www,everettwa.gov/permits <br /> (Blue or Black Ink Only Please PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 302z (Ittlie Aittl Gig z.1 0 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ...-..--- <br /> .......---,. <br /> CONTACT INFORMATION <br /> ....-- <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): no co 141,,, <br /> OWNER MAILING ADDRESS: STREET SO ix) vt„Aa.a,v, Iwo <br /> CITY e-,)6e.eitt- STATE VA4-'- ZIP qezfi 0 <br /> OWNER PHONE: OWNER EMAIL; <br /> CONTRACTOR NAME: E)my,..2e.c...57,- S977:-.,,.. e61--/1/60,41,.... <br /> CONTRACTOR ADDRESS: arnEer 1110 PA-C..4.... <br /> cm/ EVOLit-ar. . STATE 6_,..444-i ZIP 5,47_1)1 <br /> CONTRACTOR PHONE: H2E) 'ZS Z,-3/1,-1- CONTRACTOR EMAIL: Ki20‘ d s'St-niat.dcvm <br /> CONTRACTOR LICENSE#(REQUIRED): ..1J612.,65en-Z01--- CITY OF EVERETT BUSINESS LICENSE#(REDUIRED):001 9 C5 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ((4.7.51 5pg- <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: t Gas )11Sectric 120ther <br /> ...„.... <br /> BUILDING USE: E1SFR OTownhouse I:Duplex DADU OMuiti-Family-#Units: Commercial DAccessory Structure <br /> Type of Project: :New OAddltion DRemodel iRepair OT.I. OSign OSprinkler ODemolltion OChange of Use <br /> DESCRIPTION OP WORK: <br /> Oka, trICLAW (AMA- e.. S‘°k-t 2-1)1' • <br /> Tst., <br /> ASSOCIATED BUILDING PERMIT# if a licable: _ - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> . <br /> Fixture . Fixture Fixture <br /> List of Fixtures List of Fixtures Phalli.° List of Fixtures List of Fixturos <br /> Count Count Count Count <br /> A/C-Air Handling Units Gas Piping Backtlow PreventerSInside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> _ <br /> Clothes Dryer 1 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 Ventilatio Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove interceptor-Sand/Oil Water Service(behind meter) <br /> , . <br /> Forced Air Systems Other Medical Gas Water Valves or Fixtures <br /> . <br /> Gas Fireplace/insert/Log Roof Drains Water Heater <br /> . . <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> ater Suppress on System No.of''ea.s , <br /> Chemical Suppression System No.of Heads <br /> -..ACKNOWLEDGEMENT:!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,end 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!am authorized by the owner of this property to perform(he work(or which application is made, <br /> arid!comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> I 1 • - ---, <br /> Own e Ithor ed Agent Signature Date '(RevIsed 10/10/2018) <br />