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0 PERMIT APPLICATION 0 <br />BUILDING / MECHANICAL I PLUMBING I SIGN I SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />fPN425-?rt7-AA1n I PAX425-257-8857 I1E)averaI.toos0everettwa,aov1 wwaverefta.mv/permits <br />(Blue or Black Ink On!Y Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: qjr Al, AIV4 1) PROPERTY TA #: <br />jZ X <br />LEGAL for new construction; Short Plattsubdivislon__.,jot No.__ (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME. t TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: suer(;)Cw'�L <br />SUM VVVr ZIP <br />OWNER PHONE: ]OWNER <br />EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET Z( ZO 1'?14C-b4t <br />cny STATE ?JP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL;' <br />CONTRACTOR LICENSE #(REQUIRED): 0VGM65;XWr 0' <br />CITY OF EVERETT BUSINESS LICENSE f(REQUIR15D); 00-7 9 �15 <br />4-- <br />PRIMARY CONTACT., CI OWNER PFCONTRACTOR Q OTHER (Please SPeCify)--------- ........ . ...... ...... <br />CONTACT NAME* <br />Ij LO <br />ICONTACT PHONE: (4731 c7z--/- <br />ICONTACT EMAIL: <br />BUILDING INFORMATION <br />Existing Use of Building: lContract Price of Work: $ i <br />Proposed Use of Building: [Heat <br />Source: as OElectric' QOther <br />BUILDING USE: [3SFR ElTownhouse ODuplex 0MuItI-FsnnIIy-#UnIts.-..OCommercial E]Accesso!yStructure <br />-,-11ADU <br />jypeofPro jact: ONew ElAddition '&ernodel []Repair 1JT.I. 0SIqn IJSprinkler ElDemolition OChangeaflice <br />DESCRIPTION OF WORK: <br />Ac A ?-COA GL Ave On rt <br />ASSOCIATED BUILDING PERMIT #Llf,applicable): <br />MECHANICAL <br />PrzkmiT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Future <br />Count <br />List Of Fixture,$ <br />Fixture <br />count <br />List of FUtures <br />Fixture <br />count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C - Air Handling Units <br />Gas Piping <br />Backilow Preventer (inside Bldg) <br />Shower, Tub, or Combo <br />Bolter <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Slnk-Residential (kitchen,bath,bar) <br />Duct System (Remodel) <br />Refrigeration <br />DrinkimFountain <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 &e 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/tall <br />Water Service behind meter} <br />Forced Air Systems <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/inssrttLog <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Elector or Sump Pump <br />Other: <br />Water =t!�Presslon system <br />E—]N:o. <br />of =Head-s <br />Chemical Suppression System jjNo. <br />o,,,e,,,,s <br />ACKNOWLEDGEMENT, I have reviewed this application and oonrinn the Information contained herein Is true and correct, Work done pursuant to this penult must comply win <br />current Woral, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom, Deviations must rust be authorized In writing from the <br />Building Motel before belng authorized under any ck-camstance. 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 290,=4 WAC. <br />City of Everett Official tine Only <br />PE mRMIT # <br />lo 0 '- 01q <br />(Revised 10/10/208) <br />