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® PERMIT APPLICATIOS <br /> BUILDIN�*'�. MECHANICAL I PLUMBING I SIGN , PRINKLER I DEMOLITION <br /> EVERETT ., -rt Y OF EVERETT PERMIT SERVICES <br /> in�ii.�•�J 4/'� 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 0 <br /> \ WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) pull <br /> SITE INFORMATION <br /> PROJECT SITE ADDRESS: �/ � g' 1 u l l /toe 5 q �)c PROPERTY TAX#: <br /> LEGAL for new construction: ,sort Plat/subdivision "J C r4 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ,I I <br /> OWNER NAME: a iit 1z�G�C a__ V o TENANT BUSINESS NAME(Commercial):A�j4)c{i 'd �-t pp�e,,-o <br /> OWNER MAILING ADDRESS: STREET /Q;C(f c' /(III �e `�`e cc`''f t( <br /> CITY,(l`L•' 1 STATE fX) 0 ZIP I `) L/ <br /> OWNER PHONE: OWNER EMAIL: 1 <br /> CONTRACTOR NAME: I( ii`It.jci.. (1( C� ,x) ) <br /> CONTRACTOR ADDRESS: pjipose_, <br /> ET [ 1Q i- �/1/l�,Y),V(( (` / ---���C � cAA)G <br /> CITY .eN L 4- STATE W G\ �ZIP 9 © <br /> CONTRACTOR PHONE: ("PS\ �7-6 7�J CONTRACTOR EMAIL: O t(PL,f l2c)`,Q c-Ul�Ct I(7 lvta,,lc"' <br /> CONTRACTOR LICENSE#(REQUIRED) 4)L)7D l'3 C N U CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):: <br /> Vc-PRIMARY CONTACT: ,OWNER 0 CONTRACTOR ❑ OTHER(Please Specify) (sus-, O 5 <br /> CONTACT NAME: CONTACT <br /> V lU CONTACT PHONE: //2 - 27- -- 6 }-1 S/ <br /> /`Ltet,S' ) . CONTACT EMAIL: 2c S -f-(,tEz 6,0 JJc ( • u/UC-r1 <br /> �/ BUILDING INFORMATION <br /> _ r <br /> Existing Use of Building: Contract Price of Work:$5 y-8 /•O 0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. IIdSIgn ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: I ��-ote <br /> Li aicitd t eie.' Sr yt <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count 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 <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 /> 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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# nirill 1.1 <br /> O �� <br /> caner/Authorized Agent Signature J Date (Revised 4/15/2019) )�� <br /> Z <br />