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411P II
<br /> PERMIT APPLICATION
<br /> INI
<br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER/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 1(E)everetteps@evereltwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> (),
<br /> PROJECT SITE ADDRESS: ,,,:II jt2 -- CI PP i (.3 ti PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: Clii&At 7.,_ r,7///?6,4 1,11- TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: smear 6-7/PP i
<br /> CITY -:74t 57, STATE IA-li) , ZIP
<br /> OWNER PHONE: (1-1ZS") '26'" "" 3 2 5 e< .. OWNER EMAIL: C 4e-,/,,Iii I ph 4.-r(ii ,ii i to:( I. (,',0/(4
<br /> CONTRACTOR NAME: Z;::1,,t7,"67:(2: ) Si r-c',, 84i/1 r ,-... A(t_
<br /> CONTRACTOR ADDRESS: STREET 2-( 7,I:) .,-
<br /> CITY C-:VCIe.E-ir- , STATE if III , ZIP
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<br /> CONTRACTOR PHONE: 1 L i-r.?CT) Z si 2._ ii /4 CONTRACTOR EMAIL: Ar/7")-I c...' k)'H;S://4 If,
<br /> CONTRACTOR LICENSE#(REQUIRED):7- C4.:://.6',.C CO?2.4.4- ,CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): CO 1
<br /> PRIMARY CONTACT: DOWNER ErCONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: -.2 CONTACT PHONE:('-'t 7 i f:', '
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<br /> /CU:A,'" , ft C e) CONTACT EMAIL: V 6'.?,1.<0...(e'S ':,,„frj
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ c)CO ---.'
<br /> Proposed Use of 9uilding: Heat Source: DGas taEtectrIc ClOther
<br /> BUILDING USE:Ad SFR OTownhouse ODuplex DADU 0h/101-Family-#Units: EiCommercial accessory Structure
<br /> Type of Project: ONew OAdditIon ORemodel ORepalr ;t5T:1. OSign OSprinkler ODemolltion OChange of Use
<br /> DESCRIPTION OF WORK: -L,' c t_. -•-te 5, ,-! - i 1,,,_ ,N c,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
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<br /> Fixture i Fixture Fixture
<br /> List of Fixtures Fxture 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-Commercial(3-comp,prep,floor)
<br /> . Clothes Dryer i Heat Pump&Ductiess Dishwasher Sink-Residential(kItchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utilly,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatlor Floor Drain Toilet
<br /> Exhaust Hood(Type I) ,.., (Not Heat/AC system) Hose Bibb —urinal
<br /> Exhaust Hood(Typal)) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/011 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
<br /> -No.ofTfeads
<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 dons pursuant to(his 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 I am authorized by the owner of this properly to perform the work for which application is made,
<br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAG.
<br /> City of Everett Official Use Only
<br /> PERI a....... 0 .--1
<br /> Owner/AuthOrized Agent Sigr'iath`re Date (Revised 10/10/2018)
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