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PERMIT APPLICATIOi—
<br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> �Blki- Black Ink O 410-1 as , mr�a�, r,��0`RO'JEC SLTE INFORMATI9N =;�G - . ',, . 1110' �' G . ,I"'�'_,
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<br /> PROJECT SITE ADDRESS: _���.. 3 V I /€4 SAM�( v V /� PROPERTY TAX# 05' :
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (°' (attach copy of long legal description)
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<br /> OWNER NAME: ley" E,,, flCSS 6�,/►t_ _ c,
<br /> TENANT BUSINESS NAME(Commercial): `L\JM ft. Ctage
<br /> OWNER MAILING ADDRESS: STREET /' p 15C 4►e , ie A S7 .. ic,A Q/����j►
<br /> CITY &et e�e STATE Who ZIP�(._,Z'7
<br /> OWNER PHONE: .•/ OWNER EMAIL: "' IV--
<br /> CONTRACTOR NAME: .i to 1A, ov-i W(
<br /> CONTRACTOR ADDRESS: STREET c)002 0 G/�A SU);CITY STATE VI //1 ZIP' j
<br /> CONTRACTOR PHONE: 110/0 l 0' 151 CONTRACTOR EMAIL: \«l VVVVV{ YY✓
<br /> CONTRACTOR LICENSE#(REQUIRED): Vl f ti C bG L.1362,P CITY OF EVERETT BUSINESS LICENSE#(REQUIRED*5620
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ETHER(Please
<br /> Specify)
<br /> CONTACT NAME:` ���`_ , •`�„t,, •,�__ JTACT PHONE:6 52 S2, 2.453 L
<br /> 1(rt 1_ "nG.r ��r1�r j./�i��lvbTl� G7�C`p��ITACT EMAIL: T / gal�GUZ.NL''"ejc,/-e
<br /> . a itg:' g y LDI,BUING INFORMATIox , v 1 m .l ..
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<br /> Existing Use of Building: Y/611 8 (iL. 4 .kk it tj 4 of Work:$ g•,9, 000
<br /> Proposed Use of Building:e(ee,r ,~s'f glbIN Heat Source: ❑Gas Mierectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: NeOmmercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair PI`.I./ ❑Sign ❑Sprinkler EDemolition ❑Change of Use
<br /> DESCRIPTION OF„, WORK: a LG''t
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable): .Go+ •
<br /> '.`ii liu;?�€..�°40,0011411004114#0001,00111111::.P�+�, ,� (ioPN"' 1u H i�^i i'I"i n r u.��: ww4�mwr�uP�!nm .,.c+-:,n a�i+w,�.,_
<br /> Wl�i�ll !o ';;'w iMj��!i!i!Ii��)i���it r i'hl!l,�l��p%°.:';` i{' p �Ii /„+. '��ii! .�t�w MI�I d S ,ar”.
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<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 /> SPRINIC /-Srl PPRESS1ONf 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 .eing 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 /> • .comply with the =ate Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> 111111 irokrir. ,• 4 / ) PERMIT#
<br /> IV I 0\ '—' n15
<br /> O? • ""•�uthorized Agent Signature I.te (Revised 10/10/2018)
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