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y PERMIT r,PPLICATI•l IN
<br /> tUILDIrJG/MECHA ICAL/PLUM;INNG/SIG /SPRINKLER/DEMOLITION
<br /> 44.10,=4, _= CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> Was or Elack Ink*My Please) Pi;CJFCT SITLII.FORM.TI®IIS b. _
<br /> PROJECT SITE ADDRESS: 13021 g„,,,v...,c . 'P. k5-2c
<br /> - —
<br /> PROPERTY TA1C#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> COI4Tr CT INFORMATION =
<br /> OWNER NAME: cc eNita, P f ._TENANT BUSINESS NAME(Commercial): _..._.._..__--
<br /> OWNER MAILING ADDRESS: STREET 130M -t)c>'_:rA , +�_ A ryc
<br /> —CITY STATE IP �y
<br /> OWNER PHONE: i?--5 3- r ,,511 OWNER EMAIL: .CCC .
<br /> CONTRACTOR NAME: W (}r CINNI. J--- {. ., .rza.t-kt.(/1 -1,k/l Ce, I/JC
<br /> CONTRACTOR ADDRESS: STREET pp7Q ` t' - ST - yr�r�
<br /> CnY 0.OnkIWN STATE 9 JVI -- ZIP 9 rod9
<br /> i
<br /> CONTRACTOR PHONE: 95-.'Z,_.. 41q,),1 7 CONTRACTOR EMAIL: Q cy(ri c, �a��o 60 ,..f-�y yt
<br /> CONTRACTOR LICENSE#(REQUIRED): (A1,AQL_q 3 .(�i � CITY OF EVERETT BUSINESS LICENSE#REQUIR`ED:CE....
<br /> PRIMARY CONTACT: 0 OWNER ii4 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT
<br /> cNAME: CONTACT PHONE: ' g. �)S.s -
<br /> l_JVGid �.fi. kVO CONTACT EMAIL: 4::::) 0iY ez.),"'cxie fl((Jlo(' n0 .e 6,vt.
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Y&j – Contract Price of Work:$ 'VDD /9, —
<br /> r
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> • BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU RlMulti-Family-#Units: R-203❑Commercial DAccessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION� OF WORK: f
<br /> `9 '" vo\l ar t/!,_ t 5 ev . e6v l 7 ✓`n r W etA t t,„. k r,s,\,\-sm., ‘A-c.,-)c_ ` -
<br /> V .-.-_....-
<br /> ASSOCIATED BUILDIN T#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Future 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 /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless i Dishwasher Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration i Drinking Fountain i Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatio 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 I 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:/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.lam 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 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> a\--- --' IIN--- 1 2,,\9-\\k% . Pt3fyitT#
<br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018)
<br /> Z t Z 2- 023
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