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MIN • PERMIT APPLICATION. <br /> BUILDING /MECHANICAL/ 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: /tir'r`J/ /-//Wi Tr ,&6 Sc4-+re 5-05- PROPERTY TAX#: DC)zj z/y��pg.5C 3 OC') <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /``.L) Z- /-/A i Tt L LC TENANT BUSINESS NAME(Commercial): /*,"'MF /jy/:; <br /> OWNER MAILING ADDRESS: STREET P• p . /5 OA j 2 6, 7 1 <br /> _,,,,,,,,,--Er) �l/e�(�,E77 STATE j/Ufi ZIP C7G7 Z:.0& <br /> OWNER PHONE: (- OWNER EMAIL: <br /> CONTRACTOR NAME: C <br /> E Sb1Jtg T <br /> CONTRACTOR ADDRE S: TREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> -t\Sc1 �j CONTRACTOR LICENSE#(REQUI D): ID <br /> OF EVERETT BUSINESS LICENSE#(REQUIRED) , II <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ,Q OTHER(Please Specify) j- l'G/4// --G T <br /> CONTACT NAME: / CONTACT PHONE: (Y2`;) 2S 2- 2/5; <br /> J 4 l n e,/�e POG✓! CONTACT EMAIL: c-Va/7r t✓//e- G, 7.4 /7.,fec re:,c. <br /> BUILDING INFORMATION <br /> Existing Use of Building: hf=:'/G i Contract Price of Work:$ , O t>C-) <br /> Proposed Use of Building: l'`C/GE Heat Source: OGas DElectric ❑Other_ <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ,gcommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair OT.I. ❑Sign Sprinkler ❑Demolition EChange of Use <br /> DESCRIPTION OF WORK: pro crld6 ,2 f,C/'7/kJj t)_f-(4) e er7 7"0JG c f 6i-c=,? 9-7, ?ee 5- <br /> a,„ <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 /> 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/InserULog 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 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 /> �� <br /> PERA 9 cor- <br /> 1,>Gz'Z ✓�/ g7iv Zt-- 2)i `C BUY c.. r <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br /> /L <br />