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PERMIT APPLICATION
<br /> /� .��� BUILui 1 MECHANICAL 1 PLUMBING 1 SIGN J SPRIPIHfeER I DEMOLITION
<br /> #1111P0/141 ."—.4—
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 58201
<br /> {P)425-2574810 ( FAX 425-257-8857 I{E)eve rettepseverettwa.gov I wrntw.everetiwa,govlpermits
<br /> PROJECT SITE ADDRESS: 7 7 57-4-4„ {-"" PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision __.. .._. Lot No, (attach copy of long#eget description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: t')0 r" Yuri - 0 t t TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: slayer .2--7'S -7 5"--4-t, -.
<br /> CCTe' eV -' stints !unit P ZIP 'T ie
<br /> OWNER PHONE: Li Z5.: i -,2„„ OWNER EMAIL: /
<br /> 'CONTRACTOR NAME: ✓ °fid b C"e., ,)' p
<br /> CONTRACTOR a (j tiEET "P I �-:t'"" p..� )`7"
<br /> coy "s� Jt+
<br /> 'I t ' +STATS �. "1. 27,PyTrL..-2
<br /> CONTRACTOR PRONE )'q t fg;' 'TS7-15 CONTRACTOR EMAIL: VLA/ 1-4.4.v -S C,In 4.4',cC4 *
<br /> CONTRACTOR LICENSE#(REQUIRED);lewd'100,+- 1,C,t ems} CITY OF EVERETT BUSINESS.LICENSE#{REQUIRED): �i
<br /> PRIMARY CONTACT:XOWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: C. --4,,,..,::- 345- "1 3
<br /> t t t CONTACT EMAIL:
<br /> Existing Use of BuildingWork:: Contract Price of $ .tet'\ �
<br /> Proposed Use of Building: Heat Source: OGas °Electric °Oth€r
<br /> BUILDING USE, OSFR OTownbouse EDuplex ©ADU EiMUlti-Family-4 Units: ,e , DCommercial DAccessory Structure
<br /> Type of Project: :New JAddition ORemodei E.Repair DT.l. OSign OSprinkler ❑Demolition 'i:Change of Use
<br /> DESCRIPTION OF WORK:
<br /> tcA-C- - „5.,,,,. ( .e.,v -c4,ic . 14w7 CA,/—,-1,-, lit c..t,,/
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): "I "ke�,'4:1,--t.,4 k-
<br /> MECHANICAL,"PEI!: ., .m—
<br /> '10104444_ ,
<br /> t k
<br /> List of Fixtures" 'n'ft° List of Fixtures Fi List of Fixtures Et�rttue List of Fixtures
<br /> Coen! faxed CgtFnf Count
<br /> KC-Air Handling Units Gas Piping :Backflow Preventer(inside Bldg) Shover.Tub,or Combo
<br /> Boiler Gab Range ,Clothes Washer Sink-Ccmrnerciai(S-comp;prep,toor) 'r
<br /> Clothes Dryer Hest Pump&Duct€ess Dishwasher Sink-Residential(iritchen,baUt;har)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain 'Sink-Ut"ddity,laundry,mop
<br /> Exhaust Fans(Residentiat) Commercial Ventilation 'Floor Drain Toilet
<br /> Exhaust Hood(Type it (Not HeatiAC system) Hose Bibb Urinal
<br /> Exhaust Hood{Type Ii) Water Heater interceptor-Grease .WestetWaier Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove tnterceptorr-Sand/CI 'Water Service(behind mete()
<br /> Forced Air Systems , ,Other. Medical Gas Water Valves or Fixtures
<br /> Gas FirepiaceilnsarttLeo i, Roof Drains 1, Water Heater
<br /> _SPRINKLER,18UPP," I .$yto M , Sestge Ejector or Sump Pump Other'
<br /> Water Suppression System No,of.teens
<br /> Ditemicai Suppression System No.of Heads
<br /> OLkyIOWLEOGEMENT:I have reviewed this appttcationand 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 rro deviations therefrom.Deviations must first be authorized in writing from the
<br /> Budding Official before being authorized under any circumstance,lam the owner,or 1 em authorized by the owner of this property to perform the work for which application is made,
<br /> end!comply with the State Contractors Law 19,27 RCW and 298.20OA WAC.
<br /> City of Everett Otrwiet Use Only
<br /> ,, " �,� t*- .-( PE f1 �:D\ D 1. ..OwnerlAuthorized At;,-Fc gneture t Date (Revised 10119/2018)
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