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• <br /> am PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING 1 SIGN/SPRINKLER/ 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 I www.everet(wa.gov/permits <br /> (Blue or Black.Ink.Only Pleas®) P.ROJECT:SiT.E•INFORMATION , . <br /> PROJECT SITE ADDRESS:11/4 `d, Tft j/— . f f PROPERTY TAX#:110 yogt,-ZZ�--b17--0a <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:� �jr`�'f M6(kfII f' TENANT BUSINESS NAME(Commercial): <br /> �/6 tti i <br /> OWNER MAILING ADDRESS: STREET� /2_ �;/ ��JJ <br /> CiTY ft.. /rr STATE 4,74 ZIP 9 5Q I <br /> OWNER PHONE#-ZS)R•Z6. ��`/ .? Z_.'_.. ....... _ OWNER EMAiL: .Z /t�f 5l �s,7:1 " f�4✓ - �L-O <br /> CONTRACTOR NAME: r O1OAi t ) <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 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: //�5- �-3'®-,- <br /> /` ��eC/, `4 //j/ CONTACT EMAIL:.5 m aS 0 B/E- <br /> -' ,BUILDING-iINFORMATiON . . <br /> Existing Use of Building: .-/'/L Contract Price of Work:$ <br /> Proposed Use of Building: 5 f/7 Heat Source: ❑Gas XElectric ❑Other <br /> BUILDING USE: ISFR ['Townhouse 0 Duplex ❑ADU ❑Multi-Famlly-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition 0 Remodel Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:e‘0.... -4 1( -,5r Tva-N4(nSc <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .• MECHANICAL_PERMIT APPLICATION: `'. PLUMBING PERMIT APPLICATION <br /> Fixture Fixrura Fixture Fixture <br /> Count List of Fixtures Count • List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) / Shower,Tub,or Combo <br /> Boller / Gas Range / Clothes Washer Sink-Commercial(3-comp,prep,fioor) <br /> / Clothes Dryer Heat Pump&Ductless / Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain J Slnk-Utility,laundry,mop _ <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain / Toilet <br /> 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 /> 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 Fireplace/Insert/Log Roof Drains Water Heater <br /> . .SPRINKLER•I.SUPPRESSIONSYSTEM_ •• 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,end local law. The granting of a permit only authorizes approved work end 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 1 am authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with the State Contractors Lew 111.27 ROW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> DLO A9041- 0( <br /> Owner Authoriz'd Agent Signature Dat (Revised 4/15/2019) <br /> 1/z <br />