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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Z F6oaci sk' t. ece-F+ L1,3(1_ qui PROPERTY TAX#: OO4`51 Z 7(aDIo( <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: etal L T24:31,9..D L__ TENANT BUSINESS NAME(Commercial):166,y),s-rearvoijilffere,uc <br /> OWNER MAILING ADDRESS: STREET --ZC ( TC > 3T • <br /> CITY E‘.)t✓2ETT STATE A. ZIP qS3zo <br /> 1' OWNER C AQ W.tAe`2t�Qd13 e C.I V%& <br /> OWNER PHONE: `� Z?�.. �9� EMAIL: Q..,. . ... <br /> CONTRACTOR NAME CC C E PT "Fu.lupe-25 C--nzw./1" 1 pJC._ <br /> CONTRACTOR ADDRESS: STREET I( , .- 7 ktA-- s+ SE t <br /> CITY � -yt STATE („�IA ZIP 960/Z_ <br /> CONTRACTOR PHONE: L ' 77/O C. <br /> -/ Z CONTRACTOR EMAIL: `��R L'G �'�j`gU/G/,�JZSC�jZG�GLP e®''1 <br /> C. <br /> CONTRACTOR LICENSE#(REQUIRED): O- (E76j 9'/Z,1.3 F CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 053 11-4 I <br /> PRIMARY CONTACT: 0 OWNER I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ` e CONTACT PHONE: 47.5 77 70 c Sett <br /> CASEY WALL CONTACT EMAIL: ekey(w CGLXI: 7( /d s vecu t?CG?Wl <br /> BUILDING INFORMATION <br /> Existing Use of Building: CO MV&EC1 hk L_ Contract Price of Work:$ k iscM0.00 <br /> Proposed Use of Building: (i'),/t((A El?C,i L.. Heat Source: kgas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: PICommercial ❑Accessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair Ill. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION ,OFF WORK: <br /> t-I-K'LQ✓1 &4e- mal UU& 1 17t5uvwGts;1-Ng r <br /> ASSOCIATED BUILDING PERMIT#( p icab e: r V <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 ,4 Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type 1) (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/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Chemical or Water ( 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 befor- .eing authorized under any circumstance.I am the owner,or tam authorized by the owner of this property to perform the work for which application is <br /> made,and compl�/th= :tate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P R T# <br /> tOL—O <br /> Ow /Aut orized Agent Signature Date (Revised 10/10/2018) <br />