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PERMIT APPLICATION <br /> "IIIPBUILDING I MECHANICAL I PLUMBING I SIGN/SPRINKLER/DEMOLITION <br /> e- <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,;EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX425-257-88667 F(E)everetteps@everettwa.gov F www.everettwa.govlpermits <br /> s <br /> 4 *4Bt _: c#i ,.. 7` .i ,.t ESETE OA .ON 7C. . _ <br /> PROJECT SITE ADDRESS: 11(,..).3 1,t , 'fit. 16 PROPERTY TAX# <br /> LEGAL for new construction: Short.Plat/subdivision Lot No (attach copy of long legal description) <br /> COIF A!G'91140 RM *Lail -, z <br /> OWNER NAME: I'-t I 16.&,. clea.l..t teal TENANT BUSINESS NAME(Commercial):'SPT 5pc1,4-=,phltsteckl <br /> OWNER MAILING ADDRESS: smtt; ZOO p, eUU3'1-4 pt,„(+t..:» ."4-e..,..4 ).1 --NteArcerti <br /> CI1Yrdt, 4 STATE IN Pc ZIP 9.5 l <br /> OWNER PHONE: A ZS•7.-97.= .2)'g OWNER EMAIL: %r1ri11 enclj} ✓t-1 Iv VA"'*.0 '� <br /> CONTRACTOR NAME::. ''T /t x.. irtt t Y"i. -41rY <br /> CONTRACTOR ADDRESS: s'aeer '2.-40# 1 v'tt't --,-.--A5.-.. <br /> r <br /> CnY 9l c,v,t17'_ sSA'IE k I n- ZIP 13 C <br /> CONTRACTOR PHONE; 4-15-. I ,Q-1 3< CONTRACTOR EMAIL: I 1 i f t, + eti va..t✓I + 0c-1-ti 'S R iu" <br /> CONTRACTOR LICENSE#(REQUIRED) baffikirdbbeij2 IA 0 CITY'OF EVERETT BUSINESS LICENSE'#(REQUIRED) 2.1 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR CI OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2. 14jS. - '," <br /> 6 -tv 1: CONTACT EMAIL: r t d <br /> } v`Gt i vido c4-- <br /> X.. . .. .a, BitiliiiiiiG t NFORM TION <br /> Existing Use of Building: Contract Price of Work:$ '2.021` . ' <br /> 45 <br /> Proposed Use of Building: Heat Source: Deas. DEtectric QUther <br /> BUILDING USE: DSFR OTowrnhouse DDuplex ❑ADU OMulti-Family-#Units: OCommercial DAccessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair OT.t. OSign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ,ME ANI AI PERMIT) ! t 7 , „-,, rt PLUMBING PERMIT PUICoiiON•.., , <br /> Fbeture gyre Fixture: List of Fixtures Fixture List of Fixtures <br /> Count List of Fixtures count , Lrst.o€Ttirrtures Count Count: <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,hati,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential); Commercial Ventiatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (lot Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type Ii) Water Heater interceptor-Grease WastelWater Piping Repair <br /> 'Exhaust Hood(Residential)" Wood Stove Interceptor-Sand/Oil Water Service(behind Meter) <br /> Forced Jr Systems Other: Medical Gas Water Valves or Fixtures <br /> las Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRR(NKI.•ER f SUPPRESSION SYS1'Ett Sewage Ejector or Sump Pump other: <br /> Water Suppression System t` No.of Heads <br /> Chemical Suppression System f No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this spp�:ation and conftm the information contained herein is true and correct Work done pursuant to this permit must comply with <br /> current federal,state,and locallaw.The wanting ofa 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 anyctrcumstance.lam the owner,or 1 am authorized by the owner of this property to Perform the work for which application is made, <br /> and f comply with :State Contractors Law 18.27 RCW and 290.200A WAC., <br /> / City of Everett Official Use Only <br /> PET oo ( <br /> a. n< Agent Signature 24) <br /> 0. (Revised 10110/2tl18)l `"\ <br /> g 9 <br />