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gyr PERMIT APPLICATIOI` <br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> (Blue or Black Ink Only (s Please)` goal <br /> SITE INFORMATION Ew4 �S-zt0/ ; <br /> PROJECT SITE ADDRESS: qOZ N. 15)Dal U2GV I AV . 1An t6E PROPERTY TAX#: c <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: `(04/0 woos TENANT BUSINESS NAME(Commercial): vk/ , ,I_ _ _ <br /> OWNER MAILING ADDRESS: STREET 1C109 q(a,t Ii Ave g, <br /> CRY Lotk.e. SkeA).&ns STATE WA ZIP ?. 8 <br /> OWNER PHONE: ffjj,(j..311— 71410 OWNER EMAIL: t 'fan D3/5- $5j 09t iot i L•Coiyllr <br /> CONTRACTOR NAME: MIA -7giicurt, <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 'OTHER(Please Specify) I-1(,(s bow,o( <br /> CONTACT NAME: CONTACT PHONE: &2-6 37'7— 2 L.. g <br /> 11©w wog 14-e. CONTACT EMAIL: Fie_bGt0 rfJnl 0 /(410D• avvv‘ <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ (P0 <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: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> COVVIM.e-rciciA k;fche•y-► <br /> 114ove hoipay[s1cfr -t-0 ri jh-t S, e +2,e. Same- t't}'z l c'v.-,c! <br /> ASSOCIATED BUILDING PERMIT#(if applicable): /Y -h' 17 tun,/O?I -j p; <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count 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 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 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 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 the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# ����� <br /> t/U ; / ° I 2019 <br /> Owner/Auth riAgent Signatu Date / (Revised 10/10/2018) <br />