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WI PERMIT APPLICATIONS <br /> WI 410BUILDING/MECHANICAL I PLUMBING/SIGN/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:agereyeph/z (( WA-/ fVEi / PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> r <br /> CONTACT INFORMATION <br /> OWNER NAME: //AIL 5c.wo J 6--jZ TENANT BUSINESS NAME(Commercial):SIWLZ e ry / Th/, es <br /> OWNER MAILING ADDRESS: STREET /////a r ve RL/I 14/11-/ <br /> CITY Fv-r ter / STATE Wig ZIP 20V <br /> OWNER PHONE: y7_3V 7--.56OO OWNER EMAIL: <br /> CONTRACTOR NAN j _S_ j%-/Z sO V A/C2Z C-3)41 <br /> CONTRACTOR ADDRESS: STREET 74 V E ,`33, <br /> CITY ( ff L)E ZIP <br /> CONTRACTOR PHONE: 6 ggq Ito& f CONTRACTOR EMAIL: /- i <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE 11(REQUIRED)kr19 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR MOTHER(Please Specify) f /t/TJ6S ,D/g'�72JiZ- <br /> CONTACT NAME: ,�f CONTACT PHONE: z45 74, I5 3 7 <br /> s.SEN u'PER- PPjll fJ'/t CONTACT EMAIL:J JflnFr 4 &L % e ex),,,,„,_, N' <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ /j_ r e CO <br /> Proposed Use of Building: Heat Source: OGas Electric OOther <br /> BUILDING USE: �SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Protect: DNew DAddition DRemodel ❑Repair ❑T.t. ❑Sign DSprinkler ❑Demolitiion ❑Change of Use <br /> DESCRIPTION OF WORK: ,— <br /> l�tsT�-� � r�it�-�, To e -� / LifisT�r A-rT�iia,,./� ® ��CitEb <br /> fern - / -35-' 5-,30' pcLES, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION I PLUMBING`PERMIT APPLICATION: <br /> Fixture Fixture Fixture Fixturecw t <br /> A/C—Air Handling Units <br /> List of Fixtures i . I List of Fixtut es ( Uiit List of Fixtures Comet I List of Fixtures <br /> Gas Piping I Backflow Preventer(Inside Bldg) (Shower,Tub,or Combo <br /> Boilerryas.Range. Clothes WasherSink Commerdat!3 comp.pre fl r) <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) <br /> Commercial Ventilatio <br /> Floor Drain Toilet <br /> Exhaust Hood(Type 1) _ 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 iWater 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 I 'No.of Heads <br /> ;Chemical Suppression System I 'No.of Heads I I I I <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 /> J City of Everett Official Use Only <br /> � % yC / IPERMIT & <br /> ir) 2. /9/2-4 alf)? —O2 5 <br /> Owner/ orized A nt Sionature Aate (Revised 10/ 2018) <br /> 1/ <br /> v <br />