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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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits F
<br /> (Blue or Black Ink Only Please) PROJECT SIT INFORMATION
<br /> PROJECT SITE ADDRESS: 321 �j�J�' pa � , PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: Cc c)e-(ck pi, _TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 1.ZOM $y0s' -c 0.
<br /> y u t..,,rcr l--CITY STATE v-[ A- ZIP 9 4,-*‘.
<br /> 1�
<br /> OWNER PHONE: ' c,, ,;3js... 5,2I 1 OWNER EMAIL:
<br /> CONTRACTOR NAME: (.77\)6\0\Oln C". .f:txtr,I._...re• 4— Rer_2‘...r,,,,.c.1Lt({/( e,i.1ce' tic _
<br /> CONTRACTOR ADDRESS: STREET `7o],i 5 6. /�
<br /> CITY 0 1l ` f W\ ' y1 STATE 1 - ZIP 9 tQd _
<br /> CONTRACTOR PHONE: .5' . X39__Alf j' CONTRACTOR EMAIL: O&or iO _
<br /> eer'i e hce oA()10io -r.644
<br /> CONTRACTOR LICENSE#(REQUIRED): 'T 0(2,140,..c1 j 3-j.0 Nk_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER g CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: (9.46 _ ,2.-s-5s -
<br /> C,: c.„.0,.....c Ca S\rtVo CONTACT EMAIL: cps",LY cu
<br /> idik,0_,Y k e (1(Ppb\,,,r►no •c Divi
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Y&S - Contract Price of Work:$ 2i) 0.
<br /> Proposed Use of Buiidirig: Heat Source: ❑Gas DElectric DOther
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units:_ g-)03❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ['Repair ❑T.I. ❑Sign ❑Sprinkler ['Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> b esmo\1V \)1-2 ,( --,\)1-2 ,( --, G r J c&V. C '&e6A r Dr I u.)GtU qr k , \NS v;\ct\-,t, 11:'C''k • -
<br /> A n CYC
<br /> ASSOCIATED BUILDIN ' '`f T • (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 Gas Range Clothes Washer 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 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 /> 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 State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> '\._ - 1 09-k\t% ' Pry 2 -
<br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018)
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