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AJ0 1,0A)6CK <br />V,+C, t i7 <br />PERMIT APPLICATION <br />BUILDING /MECHANICAL /PLUMBING /SIGN / SPRINKLEI <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P)425-257-8810 1 FAX425-257-8857 1(E)everetteps@everettwa.govI www.everet <br />(Blue or Black Ink OntV Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: <br />PROPERTY TAX #: 1At2:)Lp <br />LEGAL for new construction: Short Plattsubdivision "O70 Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: TAuut,40fj TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET � 2 4 "LC4 LILA-11,40 t7AVS <br />CITY STATE ZIP <br />OWNER PHONE: ♦ <br />OWNER EMAIL: Qa.4.t 111AA L. G,O <br />CONTRACTOR NAME: .-r q-," <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />a r-w P,Jfrr <br />CONTACT PHONE: Zoo CLOt . 4467- <br />CONTACT EMAIL' Q Q F—P-jQpLW#1 ":or( WJ 44114 <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />,g <br />Proposed Use of Building: rl 1iN-. NLJI�(a <br />Heat Source: ❑Gas ❑Electric ❑Other _ <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial OAccessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: r�+Cs11�L6��.i�� `�i G�L'� Ir�17• 'J`jA'i� j��=%==��"1�1�i <br />toc.G It'O L*- r4. F.WOAO 061L, 7- FOR'*RatmS/ AVP Wt-1 3C-E6F1NXA <br />�� ASSOCUIL G PERMIT #gif applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />coupe <br />List of Fixtures <br />Fixture <br />Co <br />List of Fixtures <br />Fixture <br />Count <br />List oWixtures <br />A/C Air Handling Units <br />Gas Piping <br />ackflow Preventer (Inside Bldg) <br />Shorub, or Combo <br />tsoijier <br />Gas Range <br />C Washer <br />-Commercial (3-comp,prep,floor) <br />CI es Dryer <br />Heat Pump&Ductless <br />Dishwas <br />Sink -Residential (kitchen,bath,bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Foun <br />? <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood T pe I) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />Water Heater <br />Interceptor-Greas <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-S Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />e Ga <br />&Vater Valves or Fixtures <br />Gas Fireplace/InsertlLog <br />Heater <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />-.R;Perains <br />fewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />I <br />JNo. 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. 1 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 />PE <br />OwnedAthorked Agent Signature Date (Revised 1011012018) <br />