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— PERMIT APPLICATIO <br /> BUILDING-/ MECHANICAL/ PLUMBING /SIGN°l 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 /> (Blue or Black Ink Only Please) PROJECT SITEINFORMATION <br /> 41 PROJECT SITE ADDRESS: .jOO(3 U JPc OLASIY1t1 'p6 `O`9i PROPERTY TAX#: Irb l f 61\ I I I/1//1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) v. Y1.e h (01, ,,,/ <br /> CONTACT INFORMATION 4 11'15 p' <br /> OWNER NAME: borly1. COflr\cr:l.n TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET b003 Lji' riA5artO 2.2Gl <br /> CITY f/ ec STATE 1ijet ZIP WO(-I <br /> OWNER PHONE: v OWNER EMAIL: <br /> CONTRACTOR NAME: fY CulSCV1 6- <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS: STREET (ZZ 1 2I d A-VC lj <br /> CITY lC� STATE��.6 ZIP�'b3 - <br /> 5 <br /> CONTRACTOR PHONE: '3-3 q---, I L-ti CONTRACTOR EMAIL: ',id,',id, �.�, , I., tvy-L ., cv-y <br /> CONTRACTOR LICENSE#(REQUIRED): }-t..CA�V\,�(�I.CD5e, "CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):03-7 Z�Z <br /> PRIMARY CONTACT: 0 OWNER *CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Zt, , o -0Ci-1 LA-) <br /> -"`^/•t 6 c Q_ tje 3()j\ K.�J (LasCONTACT EMAIL: (Las iveLso 1 0 1 1t1'Y)elt'?,SO P,1,r onn <br /> '�(j BUILDING INFORMATION <br /> Existing Use of Building: "[n d.OS'syC p\,\ Contract Price of Work:$ ST6 / (p-7'j <br /> Proposed Use of Building: T►1.6(2Sts,a fA,l Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: commercial ❑Accessory Structure <br /> Type of Project: ❑New OAddition.NNQRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION F WORK: 17m /5 d/ (E) /lc kA/X"f,S. <br /> LI PrK Qs i- to 1 ncyl Saxes cannea;w s vy, ,51 c c -urti- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): /26,4 r`7) (/ 1eLT <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 /> 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 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 10 Other:Vtrvyl gt4c 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:/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 /> cJ\2k�� — PERMIT# '/} <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) /�/` <br />