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PERMIT APPLICATION <br /> 1011111"sHop --A BUILDING/MECHANICAL/PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> 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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION. <br /> PROJECT SITE ADDRESS: 1-.? it F 1 11 et,I pL V i -Q,li ,.� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: )5-ail a 13- e A— TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET l LAIC -aq Cr7 <br /> Fv CITY W a STATE ZIP y'2 0C <br /> OWNER PHONE: p OWNER EMAIL: (( <br /> CONTRACTOR NAME: IA I <br /> CONTRACTOR ADDRESS: STREET �V <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: FrOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: O ^ -75-5 g 4 7 <br /> CONTACT EMAIL: ` !! <br /> BUILDING INFORMATION <br /> Existing Use of Building: ( "`'i '0 <br /> "' Contract Price of Work:$ <br /> Proposed Use of Building: S0 1k Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: SFR ❑Townhouse ❑Duplex ❑ADU 0 Multi-Family-#Units: El Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition ❑Remodel �Etepair CIT.!. ❑Sign ❑Sprinkler, ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: A ) �(�y e g((s f-i'i'! �-yyt r f # Etc) 1? 06, -00 3 <br /> r <br /> Ve&'' a a,yj, 5e l Jrhl /klih , Rol <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 Ventilatior 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 lam 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 /> PERMIT# <br /> (-Ag - -,42,),-5,61, E,1 tBo(p-oo3 <br /> Owner/Authorized Agent Signat e.-1 Date (Revised 10/10/2018) <br />