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<br /> PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING/SiGN/SPRINKLER I DEMOLITION
<br /> "1111111d.. --"4�� CiTY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (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: ,,�A `
<br /> �� d'[�/��i'°lr 6,,ec f-s, "c,...7/ 'PROPERTY TAX#: f2p3< C OC'�
<br /> LEGAL for new construction: Short Plat/subdivision Lot No.SA -
<br /> (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER.NAME: oep,L u t°A_ P„..yy,2,--'"#IC.y Gz.,6_, TENANT BUSINESS NAME(Commercial): S /
<br /> � �mt,,„
<br /> OWNER MAILING ADDRESS: STREET 823�- sdcO>Ili ,o..e A",
<br /> CITY 7e.,c „..L/LCl STATE �r ?a 4/0
<br /> ftJ�r ZIP
<br /> OWNER PHONE: ..-Z,5-3- 3? 2 - of2 7 'OWNER EMAIL:
<br /> CONTRACTOR NAME: ,&/%/J j/fit,/ 2AAJC.,
<br /> •
<br /> CONTRACTOR ADDRESS: STREET /20, a @ y / f 3 S
<br /> CRYr `
<br /> / C1 k t r./lee STATE CJ✓04 ZIP ?�/ 2'7.,�
<br /> q.
<br /> CONTRACTOR PHONE: 2S 3p� 6CJ�ttr
<br /> - ?77 7 'CONTRACTOR EMAIL: E
<br /> *1.."C vtJC.(zu+Cc,pvcci.T7'r diler
<br /> CONTRACTOR LICENSE#(REQUIRED):0 G'Y77/06 2 N 'CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED)r3S 035
<br /> PRIMARY CONTACT: 0 OWNER .2'CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 472 3-- c co 8._ 7' 7 7
<br /> G„LS ,3 0vc 7—f"--/Gt/ G- CONTACT EMAIL:
<br /> -d6e1,�1 7A-4,�5,�oi>�� C«.vc ras<, rrv�T
<br /> BUILDING INFORMATION
<br /> Existing Use of Building:G,�q/,4 e•-e-,ezA/6/44,,,m4cit Contract Price of Work:$ a 2_ 995, P.-S.--
<br /> Proposed Use of Building: .Soto. as Q AD c -e Heat Source: ,OZGas CI Electric
<br /> ❑Other
<br /> BUILDING USE: DSFR OTownhouse ODuplex OADU ❑Multi-Family-#Units: Jommercial OAccessory Structure
<br /> Type of Project: ONew OAddition j emodel ❑Repair OT.I. OSign OSprinkler ❑Demolition 0 Change of Use
<br /> DESCRIPTION OF WORK:
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture List of Fixtures
<br /> Count Fixture List of Fixtures Ct ount List of Fixtures Fixture List of Fixtures
<br /> Count
<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 Ventilation Floor Drain
<br /> i Toilet
<br /> Exhaust Hood
<br /> (Type ) (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
<br /> Gas Fireplace/Insert/LogWater Valves or Fixtures
<br /> 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 I 1No.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 /> ......____ 7 7//�t,/�` 6
<br /> oi Owner/Authorized A ent Si na JPERMIT# � _ `�
<br /> g Signature Date
<br /> (Revised 10/10/2018)
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