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MINI .IIII.. PERMIT APPLICATION im in <br /> ni <br /> BUILDING / InLHANICAL/ PLUMBING/SIGN /SI IKLER/ DEMOLITION <br /> E V E R E T TCITY 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 or Black milt oni /Pre ): PAOMCT SITE I$F RMATION „ I _# __,. .., <br /> PROJECT SITE ADDRESS: 570y - 4lu1217-AVE PROPERTY TAX#: ocei/M000voyoci <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTA 'I I ORMA II.O1Ca„ , , ,t,r a Y{..v . ,., <br /> OWNER NAME: 3ONA c11A ./ SIfEofb/✓ TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET Si Of s"�'otfma-lir Avg <br /> CITY Cvc.,/Q ry- / QQ STATE NAM- zip 7 2Q <br /> OWNER PHONE: 2G6, Z .. 723 II WNER EMAIL: GAI�(RALT".P C ,/11AT+L t r <br /> CONTRACTOR NAME: A 2„ e6i6fr7'✓G LLC <br /> CONTRACTOR ADDRESS: STREET 1414)30 s6TW PG w <br /> CITY STATE WA ZIP 71,026' <br /> CONTRACTOR PHONE: 2 ac— ,S/O+ 94/87 CONTRACTOR EMAIL: (ZO4Feo 2 11unpop6I . <br /> CONTRACTOR LICENSE#(REQUIRED): t_ LCITY OF EVERETT BUSINESS LICENSE#(RE IRE : k'°d( i <br /> PRIMARY CONTACT: VSWNER 0 CONTRACTOR 0 OTHER(Please Specify) 3( <br /> CONTACT NAME: CONTACT PHONE: 2(},6,,:-4 ZT-6323 l g <br /> 'J UIJl4 CONTACT EMAIL: 04L td row/ C•Jy\'�-- <br /> 0l <br /> ��uli© � H��R <br /> IN 1'IIIA'1'I�l+l_ <br /> TM,� <br /> sti_ s ril ; <br /> Existing Use of Building: Contract Price of Wor . ;� <br /> Proposed Use of�Building:� Heat Source: ❑Gas 0 Electric ❑Other <br /> BUILDING USE: l8'SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 2e—R.oaF , G 'o5 -rzora i-yz ' 4ff ' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> �, MECHANICAL:PERMIT A 41.0AI'ION,.' f.: 1UMBI ...... i ,Ai"RLICAT(ON<3c . <br /> .. . . �� � PL LI"�RM�T x, m. . <br /> Fixture Fixture Fixture Fixture <br /> Count <br /> List of Fixtures <br /> Count List of Fixtures List of Fixtures List of Fixtures <br /> Count Count <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub • • .o <br /> Boiler Gas Ran.= Clothes Washer Si • e• mercial(3-comp,prep,floor) <br /> Clothes Dryer He. 'ump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) -efrigeration 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(Typ= Water Heater Inter or-Grease Waste/Water Piping Repair <br /> Exhaust Hoo. -esidential) Wood Stove terceptor-Sand/Oil Water Service(behind meter) <br /> Force. ,r Systems Other: Medical Gas Water Valves or Fixtures <br /> e.s Fireplace/Insert/LogRoof Drains Water Heater <br /> �SPRINKLER ,SU PP?RESS, ION SYSTE o,„ Sewage Ejector or Sump Pump Other <br />/(/Vater 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.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 State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 40)06h 2- 10A--- /*ku6, L- 2 O P• R 5 90`� --033 <br /> O er/Authorized Agent Signature Dat (Revised 4/15/2019) <br />