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PERMIT APPLICATION
<br /> "IP BUILDING / MECHANICAL/ PLUMBING / SIGN I SPRINKLER / DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 440-24
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: W/1-/t /1 y t A_,.)i. �,,,'r}jt LJA-- 61c.),), :) PROPERTY TAX#: JC.I T ti; 4 \ LID C);,2� -C'
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: y-y T-jriEg 'rec.\ 'Si)K LLL TENANT BUSINESS NAME(Commercial): TOP P, I�'E. (c)i\:5 i ='>1
<br /> OWNER MAILING ADDRESS: STREET (<<,C,.Lt t, /Ur f 4/ . 7-1..k 7 (`ex
<br /> CITY Y`i ✓11 �'vy •
<br /> STATE �.,, /. ZIP
<br /> YYYP���`y.J j
<br /> OWNER PHONE: -C j�; .5`>LI c:,;>6. -�'--• 6 OWNER EMAIL: C..vr;vic..` j}G1Y'/\*r'i<(' ''v"'r(4,S.-, /�,'-e-.\-
<br /> CONTRACTOR NAME: (a6 VI 17IO Y' { e ri'e
<br /> CONTRACTOR ADDRESS: STREET (;•(2CO f CP " �Y
<br /> CITY Y )l 1,114.46,4t STATE Lii/ ( ZIP 9UA[V�8
<br /> 1-CONCONTRACTOR PHONE(XIP) . S- .J , K�- � CONTRACTOR EMAIL: Cot viae' H-cl rr'�'\( (0-,,,,c1' I , ,t_4-
<br /> CONTRACTOR
<br /> TRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (171c)-'") L',
<br /> PRIMARY CONTACT: 0 OWNER ❑ CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: r CONTACT PHONE: 'AC:..) -j; 4- 5S 1.. .�
<br /> ( v1Z( ,i S"•f e.
<br /> ./..to-
<br /> GAY
<br /> 14,
<br /> Glrn:'G. l�vvtGi�i,,i�:� CONTACT EMAIL: (^ VIC.,,%t-i' ��/:'� i� `�
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<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Av\ bHc,,? tV`"e. Te(?-+l'/ Contract Price of Work:$ f SL-; e'C'{
<br /> Proposed Use of Building: 4- 5c YJ`OA1Y Heat Source: 1 Gas DElectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑buplex ❑ADU ❑Multi-Family-#Units: OCommercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition L1Change of Use
<br /> DESCRIPTION OF WORK:
<br /> Eve- l� +{V°i rj v,.Y\L ivi) ��i.`_>i )1) ctv L \''Fse4;! r
<br /> .& \\` i t' '<r 1� \ ilii �l S % ` JJ///J
<br /> 6\,, r -Vo h ctJ-VL 'S3zc\, �' CO ` 12�. 'i vt3-� I I iry 6., 5 t ,-..t 1 h
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<br /> ASSOCIA ED 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 /> 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 /> SPRINKLER/ 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 /> Building Official before being authorized nder 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 Stato Contractor Law 98.27 RCW and 296.200A WAC.
<br /> /[ City of Everett Official Use Only
<br /> 7 // ,. /,) i;//
<br /> G, co&
<br /> p72-.)TA.,Owner/Authorized Agent Signature • Date (Revised 10/10/2018)
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