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PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING I SIGN / SPRINKLER / DEMOLITION <br />Ej/ C R G C I I CITY OF EVERETT PERMIT SERVICES <br />Y c 3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 I (E) everetteos0everettwaonv l vA&W everethua nnvir armite <br />(Blue or Black ink Only please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: / �Q I O: <br />`` <br />1+! s p e-'`i <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivisionLot No: (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: QtE2EEZ tfl) JS), TENANT BUSINESS NAME (Commercial):j?prrA,,, com mur.,rf <br />OWNER MAILING ADDRESS: smEET T10.. 51 <br />1�'[OA <br />CnY ' �f�'.z..+�J STATE Vj n, zip 99G.0G-l" <br />OWNER PHONE: <br />OWNER EMAIL: r`Q a.ti <br />CONTRACTOR NAME: A-LL EN <br />CONTRACTOR ADDRESS: STREET 3 Z 11 1 ri. HE - (fli,.,, <br />r Q� *� <br />_ CITY LN1 W (ST-6 STATE W A ZIP 9 CJ Z G-3 <br />CONTRACTOR PHONE: 3 (00 (T2 — Y 36% <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): Al I O' j (ZC.g L t 10 G <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: T4 t jj 1(�l� Zej - , 13 <br />"t� <br />CONTACT EMAIL: I-ct #.. e- J vt F} Q V, <br />BUILDING INFORMATION <br />Existing Use of Building:p Y't (vt v 1,7► g t.1 O t$ <br />Contract Price of Work: <br />Proposed Use of Building: s A vK <br />Heat Source: []Gas 11Electric ❑Other <br />BUILDING USE: ©SFR (]Townhouse ❑Duplex EIADU []Multi -Family - #Units: CJCommercial []Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel &Kepair EIT.i. []Sign (]Sprinkler []Demolition (]Change of Use <br />DESCRIPTION OF WORK: <br />ASSOCIATED BUILDING PERMIT# (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />coupe <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />AIC -Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Clothes Dryer <br />Duct System (Remodel <br />Exhaust Fans (Residential) <br />Gas Range <br />Heat PumpBDuctless <br />Refrigeration <br />Commercial Ventilator <br />(Not Heat/AC system) <br />Clothes Washer <br />Dishwasher <br />Drinking Fountain <br />Floor Drain <br />Sink -Commercial (3-comp,prep,floor) <br />Sink -Residential (kitchen,bath,bar) <br />Sink -Utility, laundry, mop <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />Exhaust Hood (Residential) <br />Forced Air Systems <br />Water Heater <br />Wood Stove <br />1 Other. <br />Interceptor -Grease <br />Interceptor-Sand/Oil <br />Medical Gas <br />Waste/Water Piping Repair <br />Water Service (behind meter) <br />Water Valves or Fixtures <br />Gas Fireplace/insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other. <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />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, 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 / comply with the State <br />Contractors Law 18.27 RCW and 296.200A WAG. <br />City of Everett Official Use Only <br />� J PERM( # <br />l� 211 - 013 <br />Owner/Authorized Agent Signature Date (Revised 1011012018) <br />j/Z <br />