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<br /> PERMIT APPLICATION•
<br /> NM
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHiNGTON (P)425.257-8810 j FAX 425-257-8857 l(E)everetteps@everettwa,gov( www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SiTE ADDRESS: t °(} t.-.1 191 isw 'cy tcl 0('1 PROPERTY TAX#:
<br /> LEGAL for now construction: Short Pie(/subdivision(,iC w i'e /' 'itLot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> P. _
<br /> OWNER NAME: CIL,CA-0 a 2Q,cti,C:, s%c. (-t,,.I TENANT BUSINESS NAME(Commercial): t I Pjtj' ,,.{ S
<br /> OWNER MAILING ADDRESS: sram Y
<br /> CITY STATE ZIP
<br /> OWNER PHONE: r} OWNER EMAIL:
<br /> CONTRACTOR NAME: Cvi.:2: '7,(� s �t94-77!� �1' 'lam%
<br /> CONTRACTOR ADDRESS: sTREEr Z/?A Pi4Gt�.4C k. ...... .
<br /> cmr E tl %"Lert - STATE Li-3v4-1 ZIP 4fiS. t,
<br /> CONTRACTOR PHONE: it-iZa) "Z.SZ-3/('-f' CONTRACTOR EMAIL: jcG0, 0 e S S Mtat.,C!Om
<br /> CONTRACTOR LICENSE#(REQUIRED): SS 2'' ["— CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):OO19 S 5
<br /> PRIMARY CONTACT: ©OWNER 0 CONTRACTOR O OTHER(Please Specify)_
<br /> CONTACT NAME: CONTACT PHONE: (4 z ) 55F tY77.-•,•
<br /> kJ 54'4.A CONTACT EMAIL: 1.-4et.,,rp,P 6 Skat, er, d10 PK q
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$._ ,Z t" tE5 2, _
<br /> Proposed Use of Building: _Heat Source: OGas DElectric ©Other,_
<br /> BUILDING USE: DSFR OTownhouse ODupiex OADU OMultl-Family-#Units: Commercial ❑Accessory Structure
<br /> Type of Project: ❑New OAdditlon ❑Remodel ❑Repair OT.I. ©Sign OSprinkier ODemolition OChange of Use
<br /> DESCRIPTION or WORK: (2; r., ,i\ elk" t k-'1:_ ,. t,4'" "-RA, tptl , °
<br /> ASSOCIATED BUILDING PERMIT# if applicable
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture
<br /> f[xture List of Fixtures Fixture List of Fixtures List of Fixtures List of Fixtures
<br /> Count Count Count Count
<br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) . Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commerclaf_13-comp,prep,fioor)
<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 Ventllatkn, 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/011 Water servlcetbehind meter) .
<br /> Forced Air Systems _Other: r• '" . Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/InsertLog Roof Drains Water Heater
<br /> SPRINKLER!SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads e
<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.lam the owner,or lam authorized by the owner of this property to perform the work for which appllcatiem Is made,
<br /> end i comply with the State Contractors Law 18,27 RCW and 296.200A WAG.
<br /> City of Everett Official Use Only
<br /> ' PERMIT#
<br /> k, , . c,q t Is i'- ?, �'Y) �0I - ODD
<br /> Owner/Authorized Agent Signature Date' {Revised 10/10/2018)
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