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iimi PERMIT APPLICATIC.
<br /> 11111
<br /> DUILDINL, I MECHANICAL/ PLUMBING I SIGN I SPRINKLER/ DEMOLITION
<br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> WASHINGTON (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: 3,C \ /6,-(,. ,, i-- PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: (i J' \4-;�� '�`— TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET )����} I 64A/\ 5k- i
<br /> CITY �y�'Qt,:=, STATE (el'
<br /> C._ ZIP � � /
<br /> OWNER PHONE: OWNER EMAIL: I
<br /> CONTRACTOR NAME: 4113O6,F?, ;()(1.Ai 31 �/eDV'kt-
<br /> CONTRACTOR ADDRESS: STREET R 3n , ,,„ „Ana t C�
<br /> CITY I"1na 6g i�'�e� STATE a�a_ ZIP J
<br /> CONTRACTOR PHONE: to s------3L 0 77 CONTRACTOR EMAIL: �4�,)�t• o(,�r� Ga 3 clip IA 415. --.4.,4--t4/N'`Ot
<br /> J
<br /> CONTRACTOR LICENSE#(REQUIRED): `v g1 5 G-751I v 6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED). 50�1 `I
<br /> PRIMARY CONTACT: 0 OWNER I CONTRACTOR 0 OTHER(Please Specify) a�
<br /> CONTACT NAME:1 ��/ t( t� CONTACT PHONE: [ 5-tJL( 6 ,�jt-f J
<br /> Ect,� I �CkV''`�( CONTACT EMAIL: J) f a e,a,'i((do v.U(5 �1 , -�'G>c,-
<br /> v { i 9G.. �} S d�!� ws
<br /> n BUILDING INFORMATION
<br /> Existing Use of Building: r-( J'`e `l/•-ere ,,,,t,g_q -- Contract Price of Work:$ ", ,J(i(Y). 01 0
<br /> Proposed Use of Building: 1 T \O P yie„,...€ ,, ,,..,..,, 4 Heat Source: OGas %Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial DAccessory Structure
<br /> Type of Project: ❑New DAddition likemodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTI QF VoRK: i ;f y S .� I 1 ,y S GJcdrv^ ), ek*e
<br /> �/ O�" . k5
<br /> ASSOCIATE BUILDING PERMITif applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Cou ist of Fixtures Co List of Fixtures Count List of Fixtures
<br /> A/C-Air Handling Units Gas Piping [ =ckflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Rai - -- - 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 I 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City
<br /> Oo�f Everett Official Use Only
<br /> V I� �
<br /> PERM4T, n 4 OLi I CI 0
<br /> WriZednJ� � cI��O-_ature Date (Revised 4/15/2019)
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