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PERMIT APPLICATIOI"'r <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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov( www.everettwa.govIpermits <br /> (Blue or Black Ink Only Please) <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7 0 W OctOS I Yt f) Q.d PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6-71- S- /)/ TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET ZC 0 lA.)• CoS to v V Cx <br /> CITY iV e1 i! (fi STATE lit) ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: -eNry\it VI50Y)- (pMOCc Pt <br /> p <br /> CONTRACTOR ADDRESS: STREET 122- I 214'01 A e- N <br /> CITY ._e {- STATE bt � ZIP 0 F-0 3Z <br /> CONTRACTOR PHONE: �^N CONTRACTOR EMAIL: ^� `�_ <br /> CONTRACTOR LICENSE#(REQUIRED): N 1° Y'F(t ��� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):037 2 <br /> PRIMARY CONTACT: 0 OWNER IXCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ''ZO(o— 5 � 3— 2-07-3 <br /> CONTACT EMAIL: K1 Ch e �►e✓Vt i sc�� ccs <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ III SLY-) <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ( 'ommercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel Repair ❑T.I. ['Sign ['SprinklerbDemolition ['Change of Use <br /> DESCRIPTION OF WORK: / ' <br /> Cc e eye s4-+n9 -7. n w l ne lI _A`' /,'kP cA4, <br /> ASSOCIATED BUILDING PERMIT#(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 /> ) 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 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 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 /> PERYM C. /// W#PI l <br /> Owner/Authorized A Signatu Date (Revised 10/10/2018) <br />