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ENE PERM ± - - CATION
<br /> ILE BUILDING 1 MECHANICA PLUMBING SIGN 1 SPRINKLER I DEMOLITION
<br /> E V E R E T TCITY 0 ""'",0101"- IT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: 22�3 tOST MO� 4Ve• V6R.R7 WA 9t4ROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: 010E1Lk- IPU).rn1517•..<3,
<br /> CONTRACTOR ADDRESS: STREET (pOSI, (.,,m. ,tQ Riii IA AVS st,.3
<br /> CITY ,ls. STATE \6..4 ZIP °►g13 j,
<br /> CONTRACTOR PHONE:20(0 q 32 S 203 CONTRACTOR EMAIL:5035®.(\-/ C Q'K t1 L,UPLA/r415 J JJL i 'CO AA-
<br /> CONTRACTOR LICENSE#(REQUIRED): / %5-312 P CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)1 4& ,
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) MAI ' 2/r7h1e)
<br /> CONTACT NAME: CONTACT PHONE:2O) 696-9@P
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<br /> 014-6- k u-- —().MEAL Vn CONTACT EMAIL: 30.13 /,,,,@) QL I l.LPU M 1 / i 60 An
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<br /> Existing Use of Building: Contract Price of Work:$ 4-..o3 S—:----
<br /> Proposed
<br /> .Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse 0 Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> ‘re/ViL Oka(JI \AA irk 17464 -it lokoki
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICALPERMIT, 1PPLIOA,TtON ;? ... . .a`,`., PLUUMBING 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 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 Pipi
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil ` Water Servi (behind meter)
<br /> Forced Air Systems Other: Medical Gas Water Valves or FriZt
<br /> Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> SPRINKLERI SUPPRESSION 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 /> Buildi Ofc% efore 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 c.y�-'lt the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> r / �Y``//Illl D��PERMITj#� ,Official
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<br /> Owner/Aut o ized Ag•. Signature Date (Revised 4/15/2019)
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