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<br /> PERMIT APPLICATION
<br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER 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.cverettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 'G'i'` eI% n 6 e& PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: p,'6,i t(i" ,` .1 1: y,,, ;h TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET Z,.y ,', -.._ r?.,.i. `i ,
<br /> CiTY f+` ' I- STATE e ZIP f
<br /> 'L
<br /> OWNER PHONE: 'f 2 -..• "• 11141.1, !!OWNER EMAIL:
<br /> CONTRACTOR NAME /r:1,'L-,k j f 4'7 f=. %f/ r i.AC
<br /> CONTRACTOR ADDRESS: SWEET t'71 ,$ r , s ti:
<br /> CITY 4.."t„l.'N1L,'S."..f..- STATE l." t , ZIP''Nze-J
<br /> CONTRACTOR PHONE: i• ? ' .`j 2 - 5/t L/ !CONTRACTOR EMAIL: 4,r ,-,I4."' rS<;t, 4, -,:( ,<I t t-1._
<br /> CONTRACTOR LICENSE#(REQUIRED):r "I;.. ' r ? �,'.. I
<br /> ' �.` CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED)n.,:;/��,5
<br /> PRIMARY CONTACT: 0 OWNER tIC,ONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:( et."t; ) i,C : -. e, 12 z.
<br /> j`' CONTACT EMAIL:
<br /> �`�-s'�,,:,r7�,,; . ' fc''.� vi l• , .`i`i'r,r 7 4 � Ltc=,•,_
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$,, 1 ta.,' _
<br /> Proposed Use of Building: Heat Source: ©Gas 1,7 Electric IOOther
<br /> BUILDING USE: )SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Fatuity-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ONew ❑Addition ❑Remodel DRepair „15T.l,, ❑ ❑Sign Sprinkler ODemolition DChange of Use
<br /> DESCRIPTION OF WORK: ,�. .• c.-'
<br /> ASSOCIATED BUILDING PERMIT#(if applicable:
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION i
<br /> Fixture F;xr,,,e 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 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 Ventilation Floor Drain Toilet i
<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 /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log 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 /> a _
<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.lam the owner,or 1 am authorized by the owner of this pmparty to perform the work for which application is made,
<br /> and!comply with the State Contractors Law ,8.2/RCW and 298.200A WAC.
<br /> / City of Everett Official Use Only
<br /> i /' <..,�/ `/ PERMIT .
<br /> /i _ -1') t0 I 1-'. D I
<br /> s
<br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018)
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