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<br /> 4rEn. PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING /SIGN /SPRINKLER /DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR,STREET.EVERETT,WA 98201
<br /> (P)425-257-8810 { FAX 425-257-8857 )(E)everetlepsoeverettwa,gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFOR AT�IO�N�
<br /> PROJECT SITE ADDRESS: �� k I ligHERTY TAX ti:
<br /> LEGAL for new construction; Short Plat/subdivision ,,,,_ ,"-y -�.,— _.... _Lot No.. ._" (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: i' i` {r) '.,..10,.‘/TriTENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: sT( eT T�'fl4,� r`
<br /> C-rY rr STAlE 3 zip
<br /> OWNER PHONE: `)1.e,;r`''"1 E..iL `t OWNER EMAIL: `� t'fC '("1 , t ��, j r , 1 s L..&t. )
<br /> CONTRACTOR NAME: �J
<br /> CONTRACTOR ADDRESS: sTerri ,
<br /> CITY 5',ATE Za,
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: AOWNER 0 CONTRACTOR D OTHER(Please Specify) _" ,�, ______ ___..___.__._..._
<br /> CONTACT NAME:IT.-ArIC�j o` CONTACT PHONE: f} �� t.
<br /> CONTACT EMAIL: 'f (340.r.(7 t t ri ;1 1 t, l i
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ � ._._._-...__.....-_-,
<br /> Proposed Use of Building: (-ACr( ,,,r, Heat Source: ❑Gas ❑Electric DOther, ,_
<br /> 1.
<br /> BUILDING USE: ❑SFR DTownhouse 0Duplex DADU DMuiti-Family-#Units:- _ „_s OCommerciai ❑Accessary Structure
<br /> Type of Project:Alew ❑Addition DRemodel DRepair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> ASSOCIATED BUILDING PERMIT"#(if applicable): 1 t t~ 1 0 Z.f ri _` �"
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> !, Fixture Fixture Fixture Fixture
<br /> List of Fixtures Count List of Fixtures Coon, List of Fixtures LtSt of Fixtures
<br /> Count
<br /> 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,tioor)
<br /> Clothes Dryer Heat Pump&Duciless Dishwasher _ Sink-Residential(kitchen,beth,bar)
<br /> Duct System(Remodel) Refrigeration _ ,Drinking_Fountain _ Sink•URIti ,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet -V " i
<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 ' 'I No,of Heads
<br /> ACKNOWLEDGEMENT!have reviewed this applicelkm anti conhrrn the infarrnetk>n Contalr:eti herein is true and correct.Work done pursuant to Urls permit must Cwop(y with
<br /> eutrenr(ecffarel,state,anti local tern,T e 9ranti0p of a permit only leuthorl apurrvadt work and no ctoy dims theatrarn,Ouvretiorrs must first be euther!zed en writff Rain he
<br /> Building Offictai before Being auth rized under y t trmsleriae I am the owne#;t)t f relit cuthotiter!dy th8 owrner of this faro rty(o perform work liar wbeh zMedon 15 n?tt€ .
<br /> taxi!comply with the Slate Qontractrxs Law 1827 FiCW and 296,700A wAC.
<br /> f 4 \ort 1-— - -' — ' ' -
<br /> City of Everett Off r
<br /> rat Use Or
<br /> Owner/Authorized Agent Signature (R /seI f+.fld�aO/6) `-. '.. . \ \(;) s
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