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• PERMiT APPLICATION i <br /> BUILDING I MECHANICAL/PLUMBING/SIGN i SPRINKLER I 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)everotteps@overetlwa.gov I wvrw,everetiwa.gov/permits <br /> (Blue or Black ifnk Only Plaaa ) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 22i)D2 _. 3-o1,AYlc ,V'`C.., PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. _ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: : . LL <br /> (1 ( ...e. ,S 1-e. l it'd' TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: smear t 7 3 L r 2.. 55 ry I;L\i`f:., <br /> cm, k JV s2.-Y--C'\-\" STATE Vs,' 7.IP CI s2'0 -/ <br /> OWNER PHONE: L-U t`"L,t-}C' _ 4, ) t.,,7 OWNER EMAIL: (}(I,J')17 t:i ry i. L. 0\`:C. i'na1 i( r Ny 'm <br /> CONTRACTOR NAME: CV -W��t9/ir-r',--Oe n L <br /> CONTRACTOR ADDRESS: a'nsr:r 2,i Zfl ,l�'A-C1:�tI�.— 1 o A !� �7 s� <br /> c v C��'5"�1.1'✓ STATE L A'$ ZIP e-f �.Jc�I......_ , <br /> CONTRACTOR PHONE: M ZST) 'ZS Z-3 i 1`f- CONTRACTOR EMAIL: jCe of q a S 9711(XI,Id 041 <br /> CONTRACTOR LICENSE#(REQUIRED): t UEQ,(SC502-'ZC)T CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):c o'7 4105 <br /> PRIMARY CONTACT: ❑OWNER El CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 7 CONTACT PHONE: (t.#.ZS7 501_ 077-7-- <br /> f /r1-0 CONTACT EMAIL: 4),e;;Spfrauer, do PIA <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ t <br /> Proposed Use of Building: Heat Source: Dees [ Electric ©Other <br /> BUILDING USE:13SFR OTownhouse ODuplex OADU OMulti-Family-#Units: OCommercial DAccessory Structure <br /> Type of Project ONew OAddition ORomodel ©Repair 'PT.!. OSign ❑Sprinkler ❑Demolition ©Change of Use <br /> DESCRIPTION OF WORK: <br /> MU/it:\—2,C:TVZ C:\ C4)-CAAS.A.0 \[V,CO" .4c* „vv-s. 0 <br /> ASSOCIATED BUILDING PERMIT# if a licable <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,t1oor) <br /> �p <br /> Clothes Dryer !,. Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> ,Duct System,Remodel) , Refrigeration Drinking Fountain r Sink-Utillty,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb lUrinal <br /> Exhaust Hood(Typo 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 Fireplaceilnsert/Log Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other <br /> Water Suppression system o.o ea s <br /> Chemical Suppression System No.of Heads <br /> -------- <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,slate,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 em authorized by the owner of this properly to perform the work for which application Is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> '`4PER IT# <br /> Owner/Authorized Agent ignature Date (Revised 10/10/2018) <br />