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PERMIT APPLICATION <br /> 040p$44/sf_A_ <br /> BUILDING/MECHANICAL/PLUMBING I SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only,Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: SIO S VJrcVEI2ET T' MALL- l/17i4---) PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 'G30$ ttJ la TENANT BUSINESS NAME(Commercial): 0 VOD.1,- 1341-CV— <br /> OWNER <br /> OWNER MAILING ADDRESS: STREET SI b> 5 V) ( Vi t^c CT N4-.L- vU"A"-1 )�/� q <br /> CITY GVE12ETr STATE W j`T' ZIP !8 2i6 3 - LL' <br /> OWNER PHONE: 1+2-5 15t-1 7O6$ OWNER EMAIL: 151-0Nv e J u01)134-+* K •C O INA <br /> CONTRACTOR NAME: Ci I NTPc5 1✓ k P .Q pilo-r 6,11010,) <br /> CONTRACTOR ADDRESS: STREET -D3Z0 Wu EST Victim-LAw '\'I N ` Di t 1 Q <br /> cm? AA)F6010-Q STATE Vv� ZIP sU0O <br /> CONTRACTOR PHONE: 2-5 3 $ij Z l cito2_ CONTRACTOR EMAIL: HAtG S g C-t/•...TriAl •CO" <br /> CONTRACTOR LICENSE#(REQUIRED): C•-I •)-rerPct CN'DJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5--9,-8c/f <br /> PRIMARY CONTACT: 0 OWNER OfCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 3 ock , CONTACT PHONE: 2-3 4352(R CIoZ <br /> CONTACT EMAIL: (-'t►rrtii J Q C.INT4°CS•LOM <br /> BUILDING INFORMATION <br /> Existing Use of Building: V ukc-► T Contract Price of Work:$c'9°("' <br /> Proposed Use of Building: i ri't3GES Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: I2t LOu416 EkISTING c5/21).--/Al lPei° 5 r-0'I OF' 0.C' <br /> w,q-(Av 4- C 0 V 612A-C.-E-- . •t-__ N6 S (^) 1 S-7-7 n4 54.F6 n--- <br /> ASSOCIATED <br /> rASSOCIATED 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 Ventilation 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 15 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 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 Officiall�Use Only <br /> r C� <br /> Owner/Authorized Agent C I ZI V9PER I # <br /> ignature Date (Revised 10/10/2018)�lJ <br />