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MI PERMIT APPLICATION II .
<br /> BUILDING / MECHANICAL/ PLUMBING/SIGN I�RINKLER I DEMOLITION
<br /> EVERETT . CITY OF EVERETT PERMIT 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
<br /> ;Blue oar Flack Ink Onry Please B.'.<`y. P*O E1 reS1TE IN ;OitM ti` .$ ,t ES{. .MM. ..: d,. „fi.. . .., z.z...
<br /> PROJECT SITE ADDRESS: Z i2$ I/1+'n Pt SE C-_.,•..-c,++f,.,,,/4 9b-tog PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> s ..' ONTACT 1$FORMATIOIt$9. ..E; _ ,t . 'a..
<br /> OWNER NAME: SIA.,...“-- 1.A/1,.,A`C,,,.-...ti TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 7 ►$!b ,714N- Pt s E
<br /> CITY 6v42 + STATE w/9, ZIP 98Z`c
<br /> OWNER PHONE: "/'z 5 - 2.2. 3 o t G. OWNER EMAIL:
<br /> CONTRACTOR NAME: (ZA-,,,.ti✓ (L,,0{...� c, ,,A Lb.,s+,,,.-4-+a-. /.-4 t-
<br /> CONTRACTOR ADDRESS: STREET /y 2 1 S L a k S c.4—$11 NM,-
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<br /> CITY c_r, wc,0j t STATE I,lA ZIP 9gOP7
<br /> CONTRACTOR PHONE: e.-17,c .. g z --I. 7/ 7 3 CONTRACTOR EMAIL: ,30,,wy c1(Z r,„,.,,ter„, ,g,.yc11�LL,,9«, y. ,,•-
<br /> CONTRACTOR LICENSE#(REQUIRED): R-A-I N I RG g Z9 CITY OF EVERETT BUSINESS LICENSE#(REQUIREJD)�1/ I{\ r ”
<br /> i. rvtut.•�•b':cuu�um:' atlH.1 >. �
<br /> .,.w,e.�J•.-...»..,.v.¢.K ee tttE amu,.•ttaw.s� m'..•+szama....a.„:'..-•c.-Poa...••..c- � w -S�w'^��.�[swceaaex
<br /> PRIMARY CONTACT: 0 OWNER pi.CONTRACTOR 0 OTHER(Please Specify)
<br /> CQNTACT NAME: CONTACT PHONE: `f Z S '7,'t"1 • g l 7 3
<br /> ci artc.. V1/4/•,e,n,.\-0./c.. CONTACT EMAIL: Ja,r,a��v cA.n,6,cvc.G,,n3 Cvv- .�.7. Co,,-,_
<br /> .:._. / . ,v.E. . . :aUILDI .II ItMATIOi ., . ,a- ._„n.. .
<br /> Existing Use of Building: IA,,,,,t_ Contract Price of Work:$ $50a
<br /> Proposed Use of Building: 4 0 v- Heat Source: ❑Gas ❑Electric CI Other
<br /> BUILDING USE: ®SFR ❑Townhouse 0 Duplex ❑ADU 0 Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition 0 Remodel faiRepair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> 1er©oC
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> .`;; ,.MECHANICAL=PERMIT APPLICATION •gei.TAPniN_,.PLUMBING PERMIT APP.14,CATiON= .
<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 /> glSPRINKLER/.SUPPRES;SION SYSTEM t„ 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and l comply wit t : eIjZ//� PERMIT#State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> 1q D9) Or
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<br /> Owner/A1'horized Agent Signature Date (Revised 4/15/2019)
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