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PERMIT APPLICATION■ <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> ilaCITY 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (fQ 9 se- S J6 ri-Ti AUL L A'7 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 90 cr BIAS WEBS CE(\ R, r,- TENANT BUSINESS NAME(Commercial): ZO NA CiL . <br /> OWNER MAILING ADDRESS: STREET "©)0 Ic6, Ak'G HE 51 J KBO F /� �`� _ <br /> CITY isec .,JLi <br /> /41c STATE /� ZIP 9 b / <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Da-KS PLornatr3 , LL.0 <br /> CONTRACTOR ADDRESS: STREET , :7,,(:)0t " (sO(tV SC <br /> CITY gai_,�,J6H-1 STATE c A zip 9g2 .R <br /> CONTRACTOR PHONE 360-333-43,37(4 CONTRACTOR EMAIL: fc i-t � <br /> Ja(NiGgbfS'(,CO1M <br /> CONTRACTOR LICENSE#(REQUIRED): QC_ L._9 6>) Z.t CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5-39,C).-23 <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 360_33-3-92-7C-/ <br /> i(f71 -1 ✓EU CONTACT EMAIL: ®Ec-) ..S(e-urie,( Gp r isi„i. ew) <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 750C) <br /> Proposed Use of Building: C I Dr%f2"/ El-pp RcDcDv'1 Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: $ ommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair t,I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:-7- 1 C'tA(J_ ` BN 'C1� R U1A ` F Looe '1AJ K, LA'J/ 3-Cr r�P <br /> 1-j3 , w--I,O AKo S� C2.) e 1 gc_- PU(tom Pe <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATI e. PLUMBING,PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count Lis 'of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC–Air Handling Units G- Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler as Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher ay' A Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation I 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(Resid: tial) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air System Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/In--rt/Log Roof Drains Water Heater <br /> SPRINKLE-'I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump / Other: C'ffC Puyvj p <br /> Py <br /> Water Suppression em No.of Heads <br /> Chemical Suppressi. System No.of Heads <br /> ACKNOWLEDG , ENT: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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> // r AP4° I.' PLT vI1. �0 <br /> Ow/Or/Aut orized Agent Signature Date (Revised 70/10/2018) <br /> (112—) <br />