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IMMI <br /> PERMIT APPLICATION <br /> MN <br /> BUILDIIv•• AVIECHANICAL /PLUMBING / SIGN / SPRINKLER / 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) .PROJECT SITE INFORMATION <br /> pp <br /> PROJECT SITE ADDRESS: i r2. OO " - PROPERTY TAX#:ZSc75 0004 O2.4.0 O <br /> i <br /> LEGAL for new construction: Short Plat/subdivision _ 1 - _Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:ppnVIDENeE.4E.p../..71} CAS Ct R . TENANT BUSINESS NAME(Commercial \ p 1 C 5 <br /> OWNER MAILING ADDRESS: STREET 12�,d0 \-: 0-114"....j...1... a\jERr-TT 4-41\1\( ArmiDEANNE <br /> CIN E\(a i-7 STATE 44P\ ZIP gg2o 8 <br /> OWNER PHONE: 11 `' OWNER EMAIL: <br /> CONTRACTOR NAME: O L'`(''' VTI[, !AGO-44%A'C ,t,..•III C • <br /> CONTRACTOR ADDRESS: STREET L«I Qj (4(g ' P 4 E \N #2s).7 <br /> CITY tA1L STATE 43\ ZIP 9801.6 <br /> CONTRACTOR PHONE: if2j_°] 74-11-- 8E34( CONTRACTOR EMAIL:3O -N.h @015/t'►,picrnecb&n\ca,(, • cote\ <br /> CONTRACTOR LICENSE#(REQUIRED): OLYMP MI( 4OI CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OI 92 co O <br /> PRIMARY CONTACT: ❑OWNER IZl'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: j`� J CONTACT PHONE: 142,g_77L..— 88 LI I <br /> `Jdt <br /> - - Hac:Do-C(U CONTACT EMAIL: , q`'1 ..\ p0tyreI c \'.i\eckoIy\ aa:k. Cbh'\ <br /> BUILDING INFORMATION - t <br /> Existing Use of Building: CL114 IC Contract Price of Work:$ 1)2_7 <br /> Proposed Use of Building: PED 6 Bc17,6,,N5 IoN Heat Source: ❑Gas OEEl,lectric DOther <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Ii�,Commercial ❑Accessory Structure <br /> Type of Project: ❑New EAddition ❑Remodel ❑Repair Iv T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: AbD nNE so PLY is.A'I - O pi <br /> 1>61-1 SON To A\Cco!-t©p`T TI, N, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION_; ;PLUMBING',PERMIT APPLICATION <br /> Fixture List of Fixtures Fixture Fixture Fixture <br /> Count Count List of Fixtures List of Fixtures List of Fixtures <br /> Count Count <br /> A/C—Air Handling Units Gas Piping — Backflow Preventer(Inside Bldg) Shower,Tub, pr Combo <br /> Boiler Gas Range Clothes Washer Sink-Commp,p <br /> Sink-Commercial (3-corn ,r) " <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 Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal A � <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residenti al) 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/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System jNo.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 front 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 /> f ` PERMI # <br /> .�dt t. Al` R- a ) ek-E%-.l 9 a OSS <br /> O uthorized Agent Signature Data (Revised 10/10/2018) <br />