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rir ''''II PERMIT APPLICATIO�III
<br /> BUILDING) M CHANICAL 1 PLUMBING I SIGN S'P'RINKLER/ 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 /> ( ,un*BlalerOniC niy Pie ce)., • r z PR A:4T ; .ttEASt0*.K.O#0:X , itM ., .E.,...,.., ...... .r. ,
<br /> PROJECT SITE ADDRESS: .6r/26 1 )(ANA Qt. (A/1141 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. . (attach copy of long legal description)
<br /> ::-f<V ,,. ...nEgi:MglREMNj.Z ,.<.,,,.... t+dN"Y4'Y tl#0EIfIIIAtltN . .._. S , . ,. MP .
<br /> OWNER NAME: FIC ii_c t'! 3 O5 ePiiipew( TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET Sre-I ZO yL),A,tJ1 ITL- ,u./kf pr
<br /> (J4 n f CITY STATE (AL' ,4 ZIP Cl c Z Ci O
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Call(/`is f, 2-o fs ( M.�iiricrif./
<br /> CONTRACTOR ADDRESS: STREET S i- 3 C7 t 2 714 pt. se I �7 77476
<br /> ich6tt:l it i S t t-L
<br /> CITY STATE ' 14 ZIP '(
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): fie, S LC CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): b 6-7
<br /> PRIMARY CONTACT:❑OWNER QONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACTI , NAME: CONTACT PHONE: L2 SS( e-// cf .- "2 4/6
<br /> C k r is (7I R&VI s CONTACT EMAIL: C'. l✓`t S .. 6,12,2,Vg� 6 D i lei s pit 1G e Y caw?
<br /> BUIfLDING.1NEORMA1 iO,N t '�
<br /> Existing Use of Building: `1 M C.... Contract Price of Work:$ ' oo % a'.2.--
<br /> Proposed
<br /> '.2.--Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: tiNew ❑Addition i {Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: l
<br /> i2 -o i+ 2 CLaS 43 To A,00 1,;okk✓tcc)vim►
<br /> ty 7,-.1 info }Ilial (' Los ifif re.› 144-VST ti6D /20044
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> - •M> 0HANICAL 0,Mit 000,0101 .,.. .... , •... .., .. ., • •PE0M1 IN .Pt hili #000*ft0,0i , :,,
<br /> Fixture Fixture Fixture Fixture
<br /> List of Fixtures List of Fixtures List of Fixtures List of • ures
<br /> Count Count Count Count
<br /> A/C—Air Handling Units Gas Piping Backflow ' -venter(Inside Bldg) ( Shower,Tub Combo
<br /> Boiler Gas Range Clothes Wash- Sink-C.• ercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher l Si `esidential(kitchen,bath,bar)
<br /> 4rDuct System(Remodel) Refrigeration Drinking Fountain ink-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 A ater Service(behind meter)
<br /> Forced Air Systems Other: Medical Gas Wa _Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains Water H-- -r
<br /> SPRINKLER ISUPPRESSION SYSTEM ,`; „• Sewage ctor 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 th; State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> —___ _
<br /> City of EverettQOfficialUse
<br /> '�Only
<br /> ' - �— � ' PERMIT#j1 \�OC�'���J4
<br /> Mr. Au ed Agent Signature Date (Revised 4/15/2019)
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