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PERMIT APPLICATION■ <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> 11 w* 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 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,Z22 cT 7j j7 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (�� mi TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDR SS: STREET �� Comae ,5� - _ <br /> CITY --.145e-,e7/ STATE WA.. /. ZIP 9 Z_O/ <br /> �� <br /> OWNER PHONE: 4.2. - `,2 -� ./4' OWNER EMAIL: c. vJ ?eI j,�, Yee'a2 .,loy <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 7 £),/2C i Q <br /> cm' �� /Gil-- ' STATE ZIP �g ig-(> <br /> CONTRACTOR PHONE: 5gr 7 CONTRACTOR EMAIL: (,<c)(26,--Q-Poo-re, <br /> CONTRACTOR LICENSE#(REQUIRED): b1e cow-k�'.(- CITY OF EVERETT BUSINESS LICENSE#(REQUI D): (-[2. ' <br /> PRIMARY CONTACT: 0 OWNER [CONTRACTOR 0 OTHER(Please Specify) __ <br /> CONTACT NAME: CONTACT PHONE: ( 06- 9/7. 6,r1( <br /> 7)Ct0/6 CQ k-) CONTACT EMAIL: b14,04.4-. x(10 j7C� col/VI <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 4� 1 - <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: MV � � � 1 ^ , it, J)Gg, 1/ .'E11T 4 IAi <br /> eP GJ N J 12, 5772aV/?A.L get/ZS/00 's1 e2, <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 aut . ' -d 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 1 comply with the Stat: .ntracto.Law 18.27 RCW and 296.200A WAC. <br /> (City of Everett Official Use Only <br /> PERM�F�tj \�O� okok, <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />