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41ErrPERMIT APPLICATION
<br /> BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERLT I,WA 98201
<br /> (P)425-257-8810 ( FAX 425-257-8857 i(E)everetteps@everettwa.gov i www,everettwa.gov/permits
<br /> (Blur,or Black Ink Only Mau) PROJECT SITE INFORMATION
<br /> `' PROPERTY TAX#:
<br /> PROJECT SITE ADDRESS: 1, L 1 \l'\..� \ C;" L-A
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ,`i��--s1 C(1\\\1).11: C-11`ctt_ TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET ''`6,0%; ( Yc:. \ .
<br /> CITY STATE ZIP
<br /> OWNER PHONE: 2 -I OWNER EMAIL:
<br /> �.i L\1 7 w.° t"" k
<br /> CONTRACTOR NAME: eAl- \ (A klA Ckkl .\
<br /> CONTRACTOR ADDRESS: STREET JJ))\ ,A�:\ ( \ \ -.-1A,,"( ''� �� —A J
<br /> CITY \12„.Q,l�� STATE LOA ZIP C.A5-C," �.
<br /> CONTRACTOR PHONE: a iii " �,t \,(Ac,,;\tl) CONTRACTOR EMAIL:i`�,T C\ A �i' , ft f / C°A J
<br /> CONTRACTOR LICENSE#(REOUIRED):(,!!! , et( Mik,,,,.) p CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)
<br /> %` J
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) �L(D� ; ,2 1
<br /> CONTACT NAME: CONTACT PHONE: t TD uy? \U{�
<br /> CONTACT EMAIL. LIN c''
<br /> i:,nC',, r`` C__,G`-( tt d
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ -71-'-'1\3'-' .
<br /> Proposed Use of Building: Heat Source: Ottis 1gElectric ❑Other. ,
<br /> BUILDING USE ❑SFRTownhouse EDuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ONew Addition ❑Remodel ❑Repair Oil. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture List of Fixtures
<br /> Count
<br /> List of Fixtures count List of Fixtures Count List of Fixtures 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.fioor)
<br /> Clothes Dryer `t 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 ventilator 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 Fireplacellnsert/LogRoof 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, d deal 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 befo beinglauthorized under any circumstance.I em the owner,ori am authorized by the owner of this property to perform the work for which application is made,
<br /> and!comply with the State cT'ontractors Law 18.27 RCW and 296.200A WAC.
<br /> i City of Everett Official Use Only
<br /> t
<br /> i„,.--------,,,,, - PET
<br /> \ 6 00 „._O 1 1
<br /> Ori — • zed •gent Signature Date (Revised 10/10/2018)
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