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® PERMIT <'.PPLICATION
<br /> BUILDING I EOHANICAL I PLUMBING I SIGN ISTRINKLEF, 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)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) . PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: //.5,2 9 ,9 - ' Se"- L'✓fie PROPERTY TAX#:rO5- 36OciDO 0()O/
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME:0e OvC' I P,�/A 0 ):
<br /> . TENANT BUSINESS NAME(Commercial
<br /> OWNER MAILING ADDRESS: STREET 3-c-04 ‘)/e/vw 1pe7c/ /4 -(2
<br /> CITY Aii(TI,17 STATE Lt/// ZIP AY:7205
<br /> OWNER PHONE: // `l `f-- / �?9/ S/,/�/��7lrZ�GL ��� car M,
<br /> 3 OWNER EMAIL «{ C 0
<br /> ���. � .. ., .M
<br /> CONTRACTOR NAME: C Ltr Ai-{J'
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT. OWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> Nei CONTACT EMAIL:
<br /> ,�// / BUILDING INFORMATION
<br /> Existing Use of Building: R-e 5 i �.P,v7/QContract Price of Work:$
<br /> Proposed Use of Building: Heat Source: ❑Gas PrElectric DOther
<br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU OMulti-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition Remodel Elf/Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:070,-,vlcr^ KS , o 5.7 /9
<br /> �'P it t d7✓' t.(�✓�'i'flr ail/ t?G} t< QVL� . ,24/S/Ct // xie-Gt.: �"�a /L1, Alee�v ''/-/C G-O.t/ Clcl „e_,, ,�
<br /> i d f i LA-3 AI Adcx, N3/0,/zs t
<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 /> NC—Air Handling Units ,( Gas Piping Backflow Preventer(Inside Bldg) ) ✓ Shower,Tub,or Combo
<br /> Boiler • ✓L` Gas Range / Clothes Washer ) ,, Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer �- Heat Pump&Ductless ! '✓ Dishwasher 4., (j`i W (,t. Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Re�'d l) Refrigeration Drinking Fountain„,,i% / V: Sink-Utility,laundry,mop
<br /> Exhaust Fans(Rlesidential) Commercial Ventilatior Floor DraiK /j 1 3 I Toilet
<br /> I 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 /> i,/I Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air Systems Other: j" Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log / 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 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 I am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the 7tiate Contractors Law 18.27 RCW and 296.200A WAC.
<br /> ,i City of Everett Official Use Only
<br /> r PERMIT#
<br /> 40 ' P/1/020)° -2 ,,,--7 ,-,i, i .-- , ;') --:-
<br /> • ner/Author ed Agent Signature Date (Revised 4/15/2019) I/
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