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= PERMIT APPLICATIO
<br /> Ail
<br /> BUILDINECHANICAL / PLUMBING /SIGNRINKLER/ 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: t •Y ; ..) S . S i` PROPERTY TAX#: CO S`/L/(''C.r(i>.) )(`
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: '�1-, 1 a;.- >� .a " r �egN,-TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET —7 k, // rb5/c> ,,S. 1 r,' (,
<br /> CITY El/e,e-114 STATE IA it- ZIP ., 2.oj
<br /> OWNER PHONE: a Q L L/d,L — � 9/� OWNER EMAIL: bR p-„/o/�,,,,Q,,.2 6- mg o. / f (0)4-'-
<br /> CONTRACTOR NAME: /,I LU Al J V Ni cf'Q,rt C9-lt, U v N J? L L C--
<br /> CONTRACTOR ADDRESS: STREET / 1 7 .2 CI `fir"` v'-G S l/ /' e t .31p.L L
<br /> CITY ev t,,e/ /� STATE w,r n
<br /> — ZIP Iq ir z a e/
<br /> CONTRACTOR PHONE: t"/2 .5 - ,a 3 / ,S'',A- 7 z CONTRACTOR EMAIL: p}-/ wri-y s U4✓404_ G-02a,,04-P k e- �/•
<br /> U ,Y .a ., U _ S�,4I ( � , RE 4i6 ---`4.," -22-1 : .
<br /> CONTRACTOR LICENSE#(REQUIRED) �'y OS- UIR
<br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR CITY OF EVERETT BUSINESS LICENSE#(REQ
<br /> R 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: o.6, t y'. /Y /y
<br /> R. i`t}r, C f-'vn4-,� CONTACT EMAIL: bg 1 AN.) G ilmo,,, C- ,,'\ . C o,y,
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Gr/t,..d-�.e„.- Contract Price of Work: $C) Sv, 6 0
<br /> Proposed Use of Building: C.��,c 4,:- Heat Source: OGas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: DNew DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler -labemolition OChange of Use
<br /> DESCRIPTION OF WORK: --- "a 0 s /N 0 ✓' L 1 t alt - i 1 Or--b ct s /3-t✓el 0%S p 0.5 e J,e- l w -t h,
<br /> no 64 4 o-,,t,z'.-t - . G.ot,* Cc—L73 5 ,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 /> A/C—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 Ventilatior 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 I 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!am authorized by the owner of this property to perform the work for which application is made,
<br /> and 1 comply with the State Contrac,. w 18.27 RCW and 296.200A WAC.
<br /> ` City of Everett Official Use Only
<br /> __ 6--- (7
<br /> loll 1 PERMIT#D►A1 ig(o oo( ,\
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
<br /> CIZ /
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