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41'6.-Inr PRIT APPLIATIM—
<br /> BUILDING ) IJIECHANICALS PLUMBING CSIGN SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> °(Blue ile*.0agk'Inlic-Of!I,Ple se) 3 PROJE,GT 1TE IH ORI AtIOt _ z'f of f..:. Ia. ..
<br /> PROJECT SITE ADDRESS: act 1700j�'•A,c, e-• PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> .. ,.. CONTACT ,NFORMATION . . ,..
<br /> OWNER NAME: \<1,�j /`� !., TENANT BUSINESS NAME(Commercial): n� `S
<br /> OWNER MAILING ADDFESS: STREET I 500 r f�, s(ztk, aO3
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<br /> ^ CgITY �O f Fam' l v STATE( f•}4• ZIP ct�, 1�D a+
<br /> OWNER PHONE: qI Q . qr fel /. �?j3 OWNER AIL: 1/3 a iJ VVVV1 n„ ..a r- n
<br /> 1 . .. , 1 'V` 1 ?. c,,i1 a-IZiS a ..
<br /> CONTRACTOR NAME: 'fin tr\C. Se kkAi CO rY-\ art
<br /> CONTRACTOR ADDRESS: STREET I Ail_o, ,e ,
<br /> CITY Ru de` STATE b//�� ZIP .g53 c$
<br /> CONTRACTOR PHONE: App. Griot. aspic, CONTRACTOR EMAIL: WGt vNa., `P1cpr\d•c2o~h ryi. Czm
<br /> CONTRACTOR LICENSE#(REQUIRED): LEGIS l' 523? CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): rj` 1i 1 0
<br /> �
<br /> PRIMARY CONTACT: ❑OWNER ;CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:', I y� t O(Rrksv 1 CONTACT PHONE: ao$• 3OO • 00 i 9
<br /> Y)O"L f C/�' V n 1 CONTACT EMAIL: t r,/,� Q,A��-n5<C,ty)
<br /> BU 1 DING INFORMATION "
<br /> Existing Use of Building: 'VQ S i ,u (ar\'\" Contract Price of Work:$ Mt,11 • 0 0
<br /> Proposed Use of Building: /Z,e 5-i' Lk rO e„* Heat Source: OGas ❑Electric ❑Other__
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure
<br /> Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: , Q
<br /> ize Az �( `k << Ve` n. re . J ts44 hew akc c = c&4 -r l cq `-` loo{'(i(v,
<br /> /y (A44;1d et ri 0(' walls ana t fs ` i(t "1 rI a -
<br /> AS�OC ATED B'ILDING PERMIT f applicable): C a d' SVk 7 •* %J 'g`iR-T t t.� t- 1 wr wRL AM'
<br /> ;MECHANICAL PERMItAPPU A01ON. , , °' .,, PLUMBING PERMIT APPWCAt O.N.;':" ''. ,.
<br /> Fixture Fixture List of Fixtures 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 4
<br /> 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 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 SystemNo.of Heads
<br /> Chemical Suppression System I 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 /> B0..uildi Official before being authorized un. ny circumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and 1 ompiy with the State Conjfactors L. :27 RCW and 296.200A WAC.
<br /> �/,A( ( City of Everett Official Use Only
<br /> /1�-� v V . -��-<—`_. 0 ( 10.1 ( 6
<br /> PER ` J l l O l b C
<br /> O erl uthorized Agent Signature Da (Revised 10/10/2018)
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