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/lip PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING /SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> itiy 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blase or Black Ink Only Please) / PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,243 #(1 A (an al A v PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> f CONTACT INFORMATION <br /> OWNER NAME: ,�l(�Q t d,. r j c.,14;t e./1 e Hari tract f ENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 5g iyd a <br /> CITY f \ U^ e STATE �/�� ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> Vt/ <br /> CONTRACTOR NAME71-1446 1 1kS ' c'n S'" Y', <br /> CONTRACTOR ADDRESS: STREET ,?f z I ( 57, (i^-S-.f A f(•(J �nI <br /> CITY 5 Y-�'/ 1,2 til aa(' STATE (11'/4- ZIP 9 g2,7 <br /> CONTRACTOR PHONE: 14Z5- (C5725 CONTRACTOR EMAIL: re4, &L75'.546,Had , Cc' <br /> CONTRACTOR LICENSE#(REQUIRED): 7-010 r l Id C W CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): , �� <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z.5 —Z-I0—Sgc35 <br /> 2.'id)e._5 CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ (`(,+ <br /> dd0 00 <br /> Proposed Use of Building: Heat Source: ❑Gas MElectric ❑Other <br /> BUILDING USE:WAR ❑Townhouse ❑Duplex DADU @Multi-Family-#Units: ❑Commercial @Accessory Structure <br /> Type of Project: CI New @Addition PRemodel @Repair DT.I. @Sign @Sprinkler ❑Demolition @Change of Use <br /> DESCRIPTION OF WORK: <br /> Ne ) /GI 7t/7 e 14 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List Fixture Fixture <br /> Count List of Fixtures • count <br /> List of Fixtures Count List of Fixtures List of Fixtures <br /> Count <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher I Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration giitP Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior 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 /> _ <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Chemical or Water I I No.of Heads ::Zi--Te, i-' /< y- 5„x <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 1 am authorized by the owner of this property to perform the work for which application is <br /> made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> gCity of Everett Official UseOnly <br /> 7 , j�A Z', ( 7 PERM? 14(162./..., <br /> 16�/ I <br /> Owner/Authorized ent Signature Date (Revised 10/10/2018) <br />