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PERMIT APPLICATION <br /> //0111"--A— BUILDING) MCHANICAL/PLUMBING/SIGN /S NKLER/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 or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Ili©y groOldtiVel f OtVe. PROPERTY TAX#:OCILS SSG021Oo <br /> LEGAL torttew construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 4. <br /> CONTACT INFORMATION <br /> T <br /> OWNER NAME: Ros -�,;if L i t5 4-wttn4S TENANT BUSINESS NAME(Commercial): El G arc i" Aar ke f <br /> OWNER MAILING ADDRESS: STREET Zoo( 5 t c J Ave <br /> cm/5re47filC STATEVA ZIP gig(Z( <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Lto �tc <br /> �tTor t / �oto?!C.a� <br /> CONTRACTOR ADDRESS: STREET 3 . G S C- <br /> CITY 444 (^,r" STATEVA /IZIP 111o62 <br /> CONTRACTOR PHONE:LIZC ZV'( qQ yO CONTRACTOR EMAIL:30SSe/i $,fnr f'pit idly Gem <br /> CONTRACTOR LICENSE#(REQUIRED):66,1FOATOISI A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):037 y 76 <br /> PRIMARY CONTACT: D OWNER grtONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: r_ CONTACT PHONE: .4 Sveg.veg. e...roR 'P►ka�r 7 <br /> `' <br /> V�s t aq fo% /kb CONTACT EMAIL: .0 g g,s yp.T q a-rte e WPM- y <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:s4,Sf <br /> Proposed Use of Building: Heat Source: ❑Gas ,lectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-family-#Units: lCommerciat ❑Accessory Structure <br /> Type of Project: ONew ZIAddition ❑Remodel DRepair DT.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use , <br /> DESCRIPTION OF WORK: (? cl,raGe. Q( u-I— nowt "1ov is ) ,e*d p"P w/ no," Sa'`t e. <br /> C.tx�D.'`G T Y t40 4, ;J 7 �t <br /> ASSOCIATED 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 /> NC-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 II 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 WasteNVater 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 I 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 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 ROW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ,41 -�`^�,h PERMIT k(�t D 1 -' ' <br /> 140/6 <br /> Owne1110410e1.-r- <br /> orized Agent Signature Date (Revised 10/10/2018) <br />