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PERMIT APPLICATIO <br /> BUILDINAVIECHANICAL I PLUMBING/SIGN RINKLER/ DEMOLITION <br /> EVERETT CITY 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: J'2-t 1 (L1 el-yy)e if a PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ' <br /> OWNER NAME: 6' f ' 0: ‘./),_ (J etZ k Cji --�'� '\ TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET `m <br /> CITY t/ C ( <br /> 9f �1 STATE (4Y ZIP er d G. t 7 <br /> �i <br /> OWNER PHONE: r 5.�1r?/,-- zit <br /> ( k /r OWNER EMAIL: Civ d� ^ ( (a) i iri r Ca 4'..f.,r g�•- 0 rt I CAA 6 14 <br /> CONTRACTOR NAME: V`/i 1 6y k 5 ( 11 t'/t 5 i ir° <br /> CONTRACTOR ADDRESS: STREET 777 9 r 4 < /1/r%'` <br /> CITY , 1 L/ (Li C c/ STATE 46_''A ZIP `)/-7 <br /> CONTRACTOR PHONE: 47_1) - / f(9"=5 9D zJ CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):d j( ,j �1 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: /i7 6-Z t t ,.a `? 5 <br /> O.ij- '7 (m - CONTACT EMAIL: 7-:C..,'tEJ( 6,B `'... ' `6- f,'i if i d r&`i <br /> • BUILDING INFORMATION <br /> Existing Use of Building: t` Y!l h/ Contract Price of Work:$ I, // 40" <br /> Proposed Use of Building: ,•`'"y /r,02 Heat Source: 'Gas ❑Electric DOther <br /> BUILDING USE: ❑SFR ❑Townhouse 0 Duplex DADU ❑Multi-Family-#Units: (Commercial ❑Accessory Structure <br /> Type of Project: DNew DAddition °Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> -Re.Prot 04 e Fa HA v--e,owls ,--�\ I e -e C a o ir, c:f ri-1 c , I P <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 _ _ <br /> _ Sink-Utility,laundry,mop <br /> _ <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 I INo.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.l am the owner,or I am 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 /> f %(5'7/ 31'0 3 6 I D <br /> Owner/Authorized Ant Signature Date (Revised 4/15/2019) <br />