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• III
<br /> im PERMIT APPLICATION
<br /> BUILDING/MECHANICAL I PLUMBING/SIGN (SPRINKLER/DEMOLITION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa,gov I www.everettwa.govipermits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
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<br /> PROJECT SITE ADDRESS: %-I? Z Z_.._ i t-+..c le-c7: :' ,ilt/ : 'PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: :.r vn M ,C 4.0. TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET I..1 2 ,,,, ! L4C le,L `t2 /`ltj i~
<br /> CITY i..-U( ,d4CPo17STATE %.�.s'-. ziP 1�t? i'1
<br /> OWNER PHONE: It",tc;) a-30 2O ( OWNER EMAIL:
<br /> CONTRACTOR NAME: t L Z reef l e, F/ _ . t5'-44-Zt I" C`:ot—r. -4 4 .
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<br /> CONTRACTOR ADDRESS: srREET Z,i -Co 1 A<-t °:'(.ca. /
<br /> CITY .U)(,,e STATE t•G44 , ZIP ("/C'./t` t
<br /> CONTRACTOR PHONE: (4.1 F' i, i,C - .,l l`°`f" CONTRACTOR EMAIL: ,Ic re"Vt.6 w2$ 1t.t +, '6(_ el e)G,,,,_.
<br /> CONTRACTOR LICENSE#(REQUIRED):(,.,.(/ k` ,,r?5('/2(,`;^ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):CO r `r..j C7
<br /> PRIMARY CONTACT: CI OWNER ' CONTRACTOR El OTHER(Please Specify)
<br /> CONTACT NAME: / CONTACT PHONE: (C/7y j ?)4 ,c ._ C 7?
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<br /> 4 `= CONTACT EMAIL: h1.0 H c`._,.t `a > I `
<br /> BUILDING INFORMATION
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<br /> Existing Use of Building: Contract Price of ork:$ ` `r C'N;.
<br /> Proposed Use of Building: Heat Source: Gas DEtectric ©Other
<br /> BUILDING USE: ©SFR DTownhouse ❑Duplex DADU ❑Multi-Family-#Units: ► Commercial DAccessory Structure
<br /> Type of Project: ©New DAddition DRemodel DRepair ©T,I. OSign QSprinkier ❑Demolition OChange of Use
<br /> DESCRIPTION OF WORK: -; cc, /
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> r MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Hxrura Fixture Fixture
<br /> Count List of Fixtures Gaunt List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer 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 Ventilatior Floor Drain Toilet
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<br /> Exhaust Hood1Type 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 /> 1 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 EjectororSump Pump Other.
<br /> Water Suppression System No.of Heads
<br /> Chemica Suppression System I No.of Heads
<br /> ACKNOWLEDGEMENT.'I have reviewed this application and confirm the Information contained herein is true and conect,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.lam the owner,or!am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the State Contrac.ctors LAW 18,27 RCW and 296,200A WAC.
<br /> r` r City of Everett Official rise Only
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<br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018)
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