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MINI <br /> all PERMIT APPLICATION <br /> BUILDING I 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 wwweverettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2:23 - 1 0q4k. N5k i SG. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copyof long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: PA-retCe• tit-ft I) oLl2bciee TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET Z2.3- 1 acr+6. Sk., 66:,.. <br /> CITY ek,VMZert STATELi.,.....14r ZIP qc2at <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: GtiozA2c.:. c?-1-/Fr -L-14T <br /> CONTRACTOR ADDRESS: STREET it Z.:b PA.,-Lc(C- <br /> CITY LE:.ut;;VmTr-- STATE L.O.A%_ ZIP CM Z.C,‘ <br /> CONTRACTOR PHONE: (if- 0 ZSZ.- 3'I I 9 CONTRACTOR EMAIL: /2C"?... ...e .S''44.4,-(4.--04• e Of" <br /> CONTRACTOR LICENSE#(REQUIRED):C--1)67065,50 e201-- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):arri 1/Sr <br /> PRIMARY CONTACT: El OWNER treONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: e,,...- CONTACT PHONE f 4 N-1 5'08....,0.7 22_ <br /> )4.7)1/4....) 3vi c-C.) CONTACT EMAIL: t- .e.,..1_ <br /> BUILDING INFORMATION <br /> Existing Use of Building: ,Contract Price of Work:$ Z S00,a" <br /> Proposed Use of Building: Heat Source: 0Gas 7:21/Electric DOther <br /> BUILDING USE: WSFR OTownhouse ODuplex DADU OMulti-Famlly-#Units: OCommercial DAccessory Structure <br /> Type of Project: ONew DAddition ORemodel ORepair OT.I. OSIgn OSprinkler ODemolltion DChange of Use <br /> DESCRIPTION OF WORK: <br /> r6c1 \,k-GU cAei(Y. 1u fNlif(11.kG <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Rowe Fbrture Fixture <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> count Count Count Count <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&Ductiess 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 Blbb Urinal <br /> Exhaust Hood(Type ii) Water Heater Interceptor-Grease Waste/VVater Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/011 Water Service(behind meter) <br /> .. _ <br /> • Forced Air Systems Other. Medical Gas Water Valves or Fixtures <br /> ----• .. <br /> I —Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other. .. <br /> Water Suppression System 1 No.of 1-feads <br /> Chemical Suppression System No.of Heads , <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and coned.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 wilting from the <br /> Building Official before being authorized under any circumstance.I em the owner,or/em authorized by the owner of this property to perform the work for which application Is made, <br /> end/comply with the State Contractors Law 18.27 RCW and 298.200A WAC <br /> City of Everett Official Use Only <br /> k._ PERM r 60 0L.1, 1 <br /> Owner/Authorized Agent Signature Date (Revised 1011012018) <br />