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mil PERMIT APPLICATI
<br /> 1112
<br /> BUILDINWIIIIECHANICAL 1 PLUMBING /SIG 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 1 www.everettwa.gov/permits
<br /> (11.**OFVOCK',Ink 901.1 Please) t. ..PRQJECT'SITE;INFORMATION: i 1'... . .. .... .., ,.....,
<br /> PROJECT SITE ADDRESS: 50 3 a L O P L t...1 e\pc z.tf PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> OlvraOT4tr0oRMATro.
<br /> OWNER NAME: tko.r1< (o 1 rt,-- 10er,.."0. (Zp TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 53 0 t 0 e L L,,,
<br /> CITY G<i—t, k STATE \.-01161- ZIP 4 820
<br /> OWNER PHONE: bei ,,,,.,41.6--3 t„§".: to 4 ct a OWNER EMAIL:
<br /> CONTRACTOR NAME: -r'S. C v„)eco Ser.,st,.t-S
<br /> CONTRACTOR ADDRESS: STREET FO M "ta,r.1/4.o.--&r,k r
<br /> CITY Q.v.t%L STATE ZIP l 63206320 3
<br /> CONTRACTOR PHONE: i'{2'. ' 1 a 50 CONTRACTOR EMAIL: Jc��^h*% , 01\04‘...A.1 QwS'Q s,rtia...k, Lo,,,,.
<br /> CONTRACTOR LICENSE#(REQUIRED): Qn�.J c u S q S� JCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 43 7 2-0
<br /> S1G» ix ,, .� � x #, ,�N •,r. waw:N
<br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: L11 c Z7 3 ( P
<br /> ..-)%",5-i.--1,‘ CMCo4,W.,1 CONTACT EMAIL: J w�i-, r,,GJo-S e' J„? j,r,.,e„k, (0......,
<br /> .=` ,. BUI.0":1 G 1.NFORMATION
<br /> Existing Use of Building: 42-CS;rle.n.ce- Contract Price of Work:$ I 10 0
<br /> Proposed Use of Building: Heat Source: was 0 Electric ❑Other
<br /> BUILDING USE: E//i FR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel iggepair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> t_1,0,A-cf.- y er S O 5 G 1 , 3 a s rt•vAc c.r-e...,'4-
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> `' MLCH tNIGAL;PERM*T t 0:13.CATION. FLUMB.IMO:PERMlif* P;L#CATI.Oi .:.,
<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) X 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 I SUPPRESSION,SYSTEM ,_ Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System I 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 /> PERMIT#
<br /> - T/I i / I i At tqffl-6to
<br /> ner/Authorized Agent Signature Date (Revised 4/15/2019)
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