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PERMIT APPLICATIO11
<br /> V ,112
<br /> BUILDIN MECHANICAL/ PLUMBING / SIGN t 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION •
<br /> PROJECT SITE ADDRESS: //7 7 J c, /z/e,- i___,,I.,,' b.,--,L',,, PROPERTY TAX#: : .r 7(_/'I eau;I—Cc)
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> / CONTACT INFORMATION
<br /> OWNER NAME: L>i„{ecr-tC S.t. l;,g,--e 0-,ei�, TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET y�el ya ij. (C-t'-, G,e,Lrt' ` v �J
<br /> CITY ��/eirz# STATE t,.19!"/ ZIP C/ ?C
<br /> OWNER PHONE: 7 z } le-ik-2:7S 4,-7 If C) OWNER EMAIL: LJ?cc`/ e/2-Iezi t 5r"i l Con,
<br /> CONTRACTOR NAME: &4,tie4iYi`e62s4 t ✓eCK`‘''S 73 /( e,,-. 0 7 .f-, ..
<br /> CONTRACTOR ADDRESS: STREET '3 3 ( l` e t r a s f'•-, / fr-
<br /> S
<br /> CITY C. /( C h' STATE L-L)4 ZIP L C'
<br /> CONTRACTOR PHONE: `/ _' 5-- 32p, 6,tt L /CONTRACTOR EMAIL: (;,CitvlC:-;✓E-1 c re lc-T,1i `--((d-iy 1.` • C c•i
<br /> #(CONTRACTOR LICENSE REQUIRED) !t!F'L.Ck ,(D.prrZ Ai
<br /> 4 Li CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 033 7 2- 7
<br /> PRIMARY CONTACT: %OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: // CONTACT PHONE: %(z)•`- z `7 Ye 4 7''
<br /> mac,,,-t_ S C `,'B."t71'`Zi ^` CONTACT EMAIL: c.--,cv ,"c,.
<br /> •
<br /> / // BUILDING INFORMATION
<br /> Existing Use of Building: /PS- J f,L c- / gi Contract Price of Work:$' ( r=- ,!'
<br /> Proposed Use of Building: .'.1,j 9'114t( Heat Source: _DGas ❑Electric ❑Other
<br /> BUILDING USE: E SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New 121Addition CIRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler jgDemolition ❑Change of Use
<br /> DESCRIPTION OF WORK: / /
<br /> �. i 7,, IJ.r �jc, (S -f v'-�4--' '/'tpkt.Cpa `/ r- ol. d ci, lid" fb t°t L- ,.:k :.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): L Z D��— 00 .
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Flxto,p 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
<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 I 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 /> i 6 I Z- t- pziT.#2_0a .....
<br /> (:)--)- Z
<br /> „0"--- ___________7/77 i
<br /> Owner1Authorized Agent Signature Date (Revised 4/15/2019)
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