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Min PERMIT APPLICATI
<br /> 11.91
<br /> BUILDING /MECHANICAL I PLUMBING /SIGN /SPRINKLER/ 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 I www.everettwa.gov/permits
<br /> (Bios+fir:BIac ,10LOntyxPleasell.4 q ; ..': .PRO;IECT SITE INF ORMA ION `.,., .',.,__. ... ...'. z, g_.. :�.... ..... .......
<br /> PROJECT SITE ADDRESS: 42,0 (aa-3 o V,2 PROPERTY TAX#: .
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> .g 7 ,> C1�NTAOti*P0R**lf.ORRggt .�.,-an. _r._ i. w ..
<br /> OWNER NAME: 1.--\-00eT `--) TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET pSc CP L-�-S\'Q; 1 c___
<br /> ^\
<br /> CITY Il v�—G STATE 0 1yZIP 7QJ _
<br /> OWNER PHONE: 19,,,,,,,W_N_E„R_91fAIL:
<br /> �. .s. ,, •..... .......„„_...... ,
<br /> CONTRACTOR NAME: ,S_CfC .\- `RJG" -V %-'(1oNi--- -\
<br /> CONTRACTOR ADDRESS: STREET S\ s(-- i,K. P-.\/_-_2. , T
<br /> � m �j C- `O
<br /> CITY ----4. .-.- --\" \ ` STATE G T ZIP L
<br /> CONTRACTOR PHONE: 0-10tP ' 9 E2 • U k CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: ❑OWNER 125 CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 9,0 co ‘ °V3 - `..)j.-a-
<br /> \'E \)CGZ- CONTACT EMAIL:
<br /> M ,r BUILDING INPCRIYIATIC.R
<br /> Existing Use of Building: Contract Price of Work:$
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign OSprinkler ODemolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ECH NI ALMPERMIT APPLICATION, ',.
<br /> . 1Vl,. . �.A. „C,. . . . . , . M, _PLUMBIIN PERMIT A1'!PLIEA"t'll<lUr; ,.. N .x ..
<br /> FixtureFixture Fixture Fixture
<br /> Count
<br /> List of Fixtures Count List of Fixtures Count List of Fixtures. Count List of Fixtures
<br /> NC—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 1 Water Service(behind meter)
<br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains 0.A.„1/Viercleater
<br /> SPRINKLER,/SUPPRESSIONsSYSTEM 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 l am authorized by the owner of this property to perform the work for which application is made,
<br /> and l comply with the State Contr. • aw 18.27 RCW and 296.200A WAC.
<br /> IP City of Everett Official Use Only
<br /> PERMIT# V ' /; 7
<br /> D(00097 0
<br /> Owner/Authorized Agent Signature 'ate (Revised 4/15/2019)
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