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iiii7iIII ''II PERMIT APPLICATIOIr
<br /> BUILDINGTNIECHANICAL/ PLUMBING/SIGN I UI RINKLER/ DEMOLITION
<br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue ar lack,Ink Iy,Pleas j s ..... 00410T SITE,r$K01 MATT 1 ' _.,. .a,_ , V,.Y _,, , , 3 r
<br /> CHQ
<br /> PROJECT SITE ADDRESS:f.(t eve-Re-g— uti,6 C PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ., CONTACT I FOI lMATIt N., s - ,
<br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): 'A 43A VIT ,
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP ,
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: c t9i Pj wi--- b i in 5
<br /> CONTRACTOR ADDRESS: STREET(6/' • . �✓- S '
<br /> CITY --rtA I (its STATE OA ZIP 1< ' f /
<br /> CONTRACTOR PHONE: �27 7-7 j2•� CONTRACTOR EMAIL:CG1.0"i� P(Ct`>�-b/c h,5 CA71.A c'� ,_Si4'�
<br /> CONTRACTOR LICENSE#(REQUIRED): - /( / Jj i Q CITY OF EVERETT BUSINESS UCENSE it gi 121.'
<br /> PRIMARY CONTACT: ❑OWNER VA CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:-0c405 K (Viet CONTACT PHONE: _2427, ....7--7-- --3 -1.5
<br /> CONTACT EMAIL: ajig1 (.C.�
<br /> prb,,b cele5(. 4-`-f t ""
<br /> , 66 ‘
<br /> ....,: ._„. e ..,s. ..._ BUILD .
<br /> .iNF ,RMAT, O _ f.. ._.
<br /> Existing Use of Building: `"' Contract Price of Work:$__77r Clio =—
<br /> Proposed Use of Building: • Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: OCommercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demo lition ❑Change of Use
<br /> DESCRIPTION OP WORK: , `��� / O( aq / O �
<br /> ,/wvi
<br /> 6 J GJ )601,_
<br /> D r p 4e,,,/cicttdi-
<br /> e h , > �J lQ \ 4 �+D
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): .
<br /> .,MER:H,ANI.CALL-PERMIT APPLICATION PLU,MBiRWFERMIITAPPLIICATIiON . ., .... ? •,. .,
<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 /' 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 /> } 'SPRINKiLER I4UPPRESSION SYSTEM s 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 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 /> CA
<br /> ` PERMIT
<br /> y ckc)q -00LA
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
<br />
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