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PERMIT APPLICATIO
<br /> In
<br /> BUILDINECHANICAL/ PLUMBING /SIGN 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:? �[ 4 f It'�3.gins.cTa'1 /�f v/EJ, vi i0e1tcf S20 ( PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 1)%tm 1't, ( 772i-//I 'J TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 2 /b (`/Ail/S ROC-1 (AliC /
<br /> CITY [ V e-J_/ (✓(14 STATE L(5A ZIP ,STGO /
<br /> e � 1
<br /> OWNER PHONE: �0.- �1 / l&oX / r, il� . . o,e
<br /> OWNER EMAIL:/✓!u �br ,11 Cl j t� C./�t,�,,,y1 y�r
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 14 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 20 3g? r 5(P Q D
<br /> ntaice CONTACT EMAIL: yka f4 22_0 l A,f,redA/7t7•e1
<br /> BUILDING INFORMATION / ,
<br /> Existing Use of Building: ,till,,r((,,��--. kr!:fir ri,„Ir.P 5 F K Contract Price of Wor �QO
<br /> Proposed Use of Building: w(in,rt -�r'S I(fit% [' ✓-_ PR Heat Source: Gas ( WElectrii /❑Other
<br /> BUILDING USE: viSFR ❑Townhous Duplex DADU Multi-Family-#Units: _E_ om
<br /> ❑ ❑ mercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition XRemodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: n(2 /y p y— �/
<br /> (v'ce mo'`J, 1-)Gyl .�h�c* bad `�U /elicr'ie,5'e- i, i 1 K �i.Cr�l (j 1 vU of 3D %��
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<br /> ,ll C `1 // fro"(-'`i I(,1 i I' f/6e tG_C r Li vet tAZi�f/ 4 74
<br /> '� X f�. , � Y1Pr�i2 Q� �. X�Z� �-�`J (.!J%'` � CJ
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): I I/
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture '''
<br /> List of Fixtures List of fixtures List of Fixtures List of Fixtures%
<br /> Count Count Count Count
<br /> A/C—Air Handling Units —f Gas- iping Backflow Preventer(Inside Bldg) Shower,Tub,orcot'tiibo
<br /> Boiler as Range Clothes Washer Sink-Commart;ial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink- sidential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain ySit(k-Utility,laundry,mop
<br /> Exhaust Fans(Residential) / Commercial Ventilatior Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb , Urinal
<br /> Exhaust Hood(Type Water Heater Interceptor-Grease /. Waste/Water Piping Repair
<br /> Exhaust Hood(R idential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air Sys "ms Other: Medical Gas Water Valves or Fixtures
<br /> Gas Firepl /Insert/Log Roof Drains Z Water Heater
<br /> SPRINT ER/SUPPRESSION SYSTEM Sewage Eje or Sump Pump Other:
<br /> Water Suppress' n System No.of Heads
<br /> Chemical Suppression System No.of Heads
<br /> ACKNOWLEDGEMENT:l have reviewed this application and confirm the information contain d 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.lam 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 C tractors Law 18.27 RCW and 296.200A WAC.
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<br /> City of Everett Official Use Only
<br /> P:10-, Fizz) ,..
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<br /> CCgi
<br /> Signature 3/5/2
<br /> (Revised 4/15/2019)
<br /> Owner/Authofized gent g If
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