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= PERMIT APPLICATI01.111
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<br /> BUILDINJ J-1�11��I�ILECHANICAL/ PLUMBING/SIGN I SPRINKLER I DEMOLITION
<br /> EVERETTCITY 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 1 www.everettwa.gov/permits
<br /> w PROJECT SITE INFORMA'TIOI ... y
<br /> tRl�e or;Bla�k t>�k�Oe�l�r.Rlea��j�y a,.. . . . ,...;�... ...-,A. ....,,.Es„ ....... ......
<br /> PROJECT SITE ADDRESS: S6/ AIJat2 v/ fl eie-, Pel PROPERTY TAX#: Oc)./6 47'7OOc O'/ CZ
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> OOSIS *It I. ORI>AVIrON
<br /> OWNER NAME: ,.4 d✓ �%–jA/ rrc' - TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET X61 A/a��-,-9 priocie j_7 .ij
<br /> CITY P-"/Z...... ----1----
<br /> ----1--- STATE hisq-- ZIP 'jsszc,
<br /> OWNER PHONE: _.„.,,,,,,,,,:..,?,.(3,-- `-ii OWNER EMAIL: /Y/af- ir/ S eiri ffi Ae•gya "e9.C-e'-�'?
<br /> CONTRACTOR NAME: '!i(/.,) S' ]. / , i' ,
<br /> CONTRACTOR ADDRESS: STREET //g/2 AA Cie-6-6* p',. .1,4,/..../ A /
<br /> CITY 7i'�y/ u� STATE (y y ZIP -2//
<br /> CONTRACTOR PHONE: -6/2c--7Gc-( fJ'7 CONTRACTOR EMAIL: .}> iejl/g'WO pc%Ila'. C-0,24
<br /> CONTRACTOR LICENSE#(REQUIRED): #30 l 3 .001000 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): SZyZ
<br /> PRIMARY CONTACT:A OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: G624-Z1)/– /77L/
<br /> /V/i7-7.9./ S,T2=jx/ 3 i CONTACT EMAIL: ~727,-1 ,, 1.e,neir-etbr--e 49at i+ -,G€C++"
<br /> . RU�IIDI'iN1G,,IRFCRMAI IO . .> .. .a,V..'a .. ., '. .. ..
<br /> Existing Use of Building: 0" ''iLrA' Contract Price of Work:$ /106
<br /> Proposed Use of Building: Heat Source: `gpas ❑Electric ❑Other
<br /> BUILDING USE:A:I,SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ONew ❑Addition ❑Remodel AilRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> j?-PL1t ,E44 A-'7 z, j7'4 MAe. i/Vi /o'& 1,-/6•A- 1 /A/ L '1J/A..) A-?-EA- _
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> .. ME.CH'1NICAL<PERMIT API' ICATIOI44PLUMBiN#PER T 40.01 IcA-1'1(1 1 . ..... >..<
<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 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 1,S;UPPRES,SION 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.lam 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 /> PERMIT# --).)\.01,0B_,
<br /> 5.-- -,g,-19 `�
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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