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II I PERMIT APPLICATION I bn �� f ,� 666 1f4/ <br /> BUILDING I MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> EVERETT CITY 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 /> PROJECT SITE ADDRESS: hi3c2 E Olivia sta/ (FRANZ R.Y) PROPERTY TAX#:a S i ;r.•aa2.I <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 914- <br /> 1 ,7 SI i r,i leery TENANT BUSINESS NAME(Commercial): /�rtr'r,7 }y <br /> OWNER MAILING ADDRESS: STREET 315 A/ /t' <br /> CITY Po fit I GiAj STATE ()/2 zip '97 Z.37, <br /> OWNER PHONE: L{ZS-26/-N'RO OWNER EMAIL: DGl'lZ;Dg f,>/6,) bA ry•CAVO <br /> CONTRACTOR NAME: a,yl e 61i,,f c <br /> CONTRACTOR ADDRESS: STREET Po gat 75'5 <br /> CITY /Ronrel..ej STATE /VA ZIP` 6; �y,�-- <br /> CONTRACTOR PHONE: -3 ' O5 /F3-3 5 CONTRACTOR EMAIL: '7,flMeC/no+'m1 <br /> CONTRACTOR LICENSE#(REQUIRED):reiPMA4SOE 0203-G CITY OF EVERETT BUSINESS LICENSE#(REQUI D):%St ( . <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ‘4.-67-3-1,5-:../19. „ (r.&2a6-3'9 e6Y? <br /> /''Cv CONTACT EMAIL: e 1ry4( - ta? a°c7t 4044 <br /> BUILDING INFORMATION <br /> Existing Use of Building: t aakenv &RC+. _ Contract Price of Work:S •CO <br /> Proposed Use of Building: R-ai -1�.�Cgfy O 4 k+ Heat Source: , Gas DElectric ['Other <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: rgCommercial ❑Accessory Structure <br /> Type of Project: ❑New ['Addition ❑Remodel ►./Repair DTA. ['Sign OSprinkler ❑Demolition ['Change of Use <br /> DESCRIPTION OF WORK: <br /> „?.901,a-cc.„ a"e.Gxis"3/? a� fopl/eles+rtr `� thifr,i44/e1.4) <br /> Ute <br /> ASSOCIATED BUILDING PERMIT#(if applicable): , .4i <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> FixtureFixture Fixture Fixture <br /> C•tint List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> APNC—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 SystemNo.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 298.200A WAC. <br /> City of Everett Official Use Only <br /> �yy2 � <br /> ist o ('�f t r <br /> Owner/Authorized Agent Signature Date (Revisedl� 10/10/2018) <br />