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x PERMIT APPLICATION Y
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<br /> 2 BUILDING I MECHANICAL I PLU I:ING I SIGN /gMRINKLER/ DEMOLI I N
<br /> EVERETTCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVRETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: ( H i`.� i o Ali ]71 PROPERTY TAX#: : , L- G/U'J I G 1 t t,
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION j
<br /> OWNER NAME: .---)0,z)Vto rii [Aov�e ‘1 ,..qier5 L\-C TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET a'P't 11 Ci I'j'L' !4-'^ 0
<br /> CITY E--A ir).- , f'' I STATE VV/YZIP -1 CY.✓�/
<br /> OWNER PHONE: 1_,—, ., ,_ ,r, . , OWNER EMAIL: ;•.:_u r, -0 rte( ,•,i I t ,of,...
<br /> CONTRACTOR NAME: V Vi ntr
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: D OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: r)__ LA) ((j a
<br /> 7)0 COM(IA,VI C
<br /> CONTACT EMAIL: rj11M,yo�v-1 Cj\ \I•tii .- 5 fAi,4 1, Uik".
<br /> BUILDING INFORMATION it 1
<br /> Existing Use of Building: `YLIk_ Contract Price of Work: $ )--.4 JJ
<br /> Proposed Use of Building: ` 'r=tn Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition DRemodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler El Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: IhOo♦.CQp5
<br /> \-2-q)1 .? V i)M boni 41 x-Wre) L. A- 3 °`!"hi)C tc- ..I-ot t t4- i,iwtt.
<br /> ''r7 tom, .->lk 0,,i a- fil..,,-, , I ,n S St b•- C w IC( 1/2-0---t--- Q-?- gin•,a�—• 1 ,,,s 4_,A). yemw 1,00,i-v- ',a,t-- i,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture
<br /> List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> Count
<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/comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> ! er/' Authorized Agent Signature DaLi
<br /> e (tel d PERMIT.# �^ nS —oD2r
<br /> Own (Revised 4/15/2019)
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