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= PERMIT APPLICATION
<br /> ix
<br /> BUILDING ECHANICAL/ PLUMBING /SIGN /a RINKLER/ 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: Z690 5 Uce v .v2v I /uf, PROPERTY TAX#: OL) `(27 O()Z 0%t oZ-
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: j6v I ,'1 QU'X t'L 1./f,v v vviAvt vi TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 2&6 et,.JCv'S`f 4ue
<br /> CITY (�v TT V 7 STATE �V ZIP��`Ll -I v/C
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<br /> OWNER PHONE: =f7j�-7 �D(O OWNER EMAIL: V•T^� Vt, 0 r �v►/,tt ' G0(42
<br /> , �._ �,ter.
<br /> CONTRACTOR NAME: iti/ko ( tiyCJ,,0,t[,es VIC1c
<br /> CONTRACTOR ADDRESS: STREET % 'Z(� 62644 6 1 A /
<br /> CITY Li � -�e „,5 �J� �STATE/- //,, 7 � ZIP ����
<br /> CONTRACTOR PHONE: 766 — �(Uei 7 6,E CONTRACTOR EMAIL: h tr4 wt1Kel/e �,�} fC 0(, import)" ii
<br /> CONTRACTOR LICENSE#(REQUIRED):M/k''l_/09 9 Q� CITY OF EVERETT BUSINESS LICENSE#(REQUIR ):
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: \\ CONTACT PHONE: 6 — -7 629 —-7Z6c9
<br /> M'VI,C. i.,, `/d„ CONTACT EMAIL: M cke ke`k C7 )(r Ca'14
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: S f e Contract Price of Work:$_ yo_ .--..---,Proposed Use of Building: '6..ti,�p Heat Source: •®Gas ❑Electric ❑Other 1 i CO
<br /> BUILDING USE: FR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: OCommercial DAccessory Structure
<br /> Type of Project: :New Wddition Xtemodel e it ❑T.I. ❑Sign OSprinkler ❑Demolition ❑ChJr
<br /> e of Use
<br /> DESCRIPTION OF WORK: �r�'G r, (ciC('Gt e„.""/t�l w / 1014 %!►u S/it/eui d 04,
<br /> i ,ci t— S
<br /> 3./ (("Lei / V'erKI r5 i r‘..-,7-4 c5s,
<br /> 0,r0144y 4,,,,e (I-
<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 /> A/C—Air Handling Units Gas Pipin: Backflow Preventer(Inside Bldg) Shower,T , r Combo
<br /> Boiler Gas R.'ge Clothes Washer Sink- mercial(3-comp,prep,floor)
<br /> Clothes Dryer Hea%-ump&Ductless Dishwasher • -Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) ' 'rigeration 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/ :g Roof Drains Water Heater
<br /> SPRINKLER/ : PPRESSION SYSTEM. Sewa jector or Sump Pump Other:
<br /> Water Suppression Syste, No.of Heads
<br /> Chemical Suppression, ystem 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 /> V( (iL-- .1-. 4 79 PERMIT1°?) 1 a• b720
<br /> Owner/Authorized Agent Sign ure Da a (Revised 4/15/2019) I+
<br /> f7
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