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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 41111W13200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:(O(( £ tQ. SC_ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:R �. kcIQ TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 'Oqc. "L± QC„ s <br /> CITY LU,Qlj STATE W ' ZIP 1l 7 ____ <br /> OWNER PHONE 'ZC) Cr-74-007 j im <br /> OWNER EMAIL: «(JJJJ <br /> CONTRACTOR NAME: ci-NeC4 ,Q,,cvzokkr <br /> ,/I () n `,k <br /> CONTRACTOR ADDRESS: STREET 17 /'T 1uQ�L„ JW <br /> CITY 0.S�J STATE CA. ZIPgro(47 <br /> CONTRACTOR PHON :(2,4- 27—Gr-SCA.� CONTRACTOR EMAIL:C t0.1cQJCt/ L 6 a il�Q t <br /> CONTRACTOR LICENS #(REQUIREDk_1[\*(30ZC§177 CITY OF EVERETT BUSINESS LICENSE#(REEQUIRED):015165 <br /> PRIMARY CONTACT: 0 OWNER 161 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT <br /> .�NAME: CONTACT PHOT/C) 2& 1c'� <br /> 1► �l .Q, CONTACT EMAIL: 111 cj rest\ <br /> BUILDING INFORMATION <br /> �" ' <br /> Existing Use of Building: Contract Price of Work:$ ©0 <br /> Proposed Use of Building: Heat Source: ['Gas 0 Electric ❑Other <br /> BUILDING USE: (iSFR ['Townhouse ['Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel gRepair ❑T.I. ❑ igen - ,❑Sprinkler ❑Demoli(ti1on,, ❑Change of Use <br /> DESCRIPTION OF WORK: cc....ortos2_, � . - �VSL. L�f,v`... c .irl ,,, _ <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 /> 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 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 i 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 /> I��• A PERT D r.. Ok )--' . <br /> .Owner Authorized Agent Signature Date (Revised 10/10/20 <br /> 9 9 ) <br />