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PERMIT APPLICATIO•
<br /> BUILDING!MECHANICAL I PLUMBING /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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 6I(i Ice%(`e(e/k r/ve_ PROPERTY TAX#: bC Li yi I6/co I000
<br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: .ce.:/(elf,1 4 -- tt Ap-e.•, I,,.6,c TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET .^ 20 5, it v ( : 6
<br /> CITY P"" cl el-ell- STATE t,,,.i.4 ZIP ^1 g G,,G' 3
<br /> OWNER PHONE: Li Z5- 7— 730 S-` OWNER EMAIL: 44)-'. I , L to yA. ,eve,
<br /> CONTRACTOR NAME: j ,,t'i'/ t 6 r7'Si(7i, -t f L.t
<br /> CONTRACTOR ADDRESS: STREET S 2cc S , 7.44d 4 IXt $ l., 6
<br /> CITY i.rr Vert°79 STATE Ig,/,,rC} ZIP 9 4)3
<br /> CONTRACTOR PHONE: Ll 7 S,-/s 7 - —73e_s"-"" CONTRACTOR EMAIL: 't/r,7/a _c,,f44;1,r t:,,,.y7
<br /> CONTRACTOR
<br /> LICENSE#(REQUIRED): .7 j7 ,OCZ. y53 ' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): L" 'I j
<br /> PRIMARY CONTACT: MOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: e -?/,j CONTACT PHONE: tt '5- e76_ 73 5
<br /> CONTACT EMAIL: poi , 2 f d e. ?r-4e4.i r['s i
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ I Ql DO,.o
<br /> Proposed Use of Building: _Heat Source: OGas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ElDuplex DADU ❑Multi-Family-#Units: DCommercial DAccessory Structure
<br /> Type of Project: ❑New (Addition DRemodel ❑Repair DT.I. ❑Sign ❑Sprinkler Demolition LiChange of Use
<br /> DESCRIPTION OF WORK: fei(a , Oatlr I e Pit 041(.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): gf !"z ,..62 1 A' 0/0 ,g [2-0--1
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture List of Fixtures Fixture Fixture Fixture
<br /> Count Count List of Fixtures Count List of Fixtures List of Fixtures
<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,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/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 ownerof this property to perform the work for which application Is made.
<br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMITIK
<br /> Owner/Authorized Agent Signatur v� Date (Revised 10/1U/2018)
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