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aim PERMIT APPLICATIC
<br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION
<br /> E V E R E T T3I/ h'e'
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> �r 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 /> { [ue,ory6 a �C,1nk nl ,Please]. .PR J T SITE INFORMAT OI , ,_ga. , -AF,,. PR..
<br /> PROJECT SITE ADDRESS: 33ori A 1 M 1 J PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: 04,4.5 tin Lyr, TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 3.2, R. Cl cr r9— i 17S R
<br /> • CIN V 2 STATE I�/} ZIP 984 c2,
<br /> OWNER PHONE:
<br /> l-fZ � . .. 5 . . ._.. ..._ ., OWNER EMAIL: V4L.tca 3�� b.v` c�!' r�►�
<br /> CONTRACTOR NAME:
<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: Is-OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> s4 � CONTACT EMAIL:
<br /> m � Z xc x s
<br /> a, „ ._, �_- itt** + 1 ORMOV .. . F, , .M_� .- ..,U ,,.
<br /> Existing Use of Building: D4.,pt. ex Contract Price of Work:$ 5G3-a '
<br /> Proposed Use of Building: 5-7-a�. � 94��Q,� pc�eck Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse SiDuplex ❑ADU ❑Multi-Family-#Units: CI Commercial ❑Accessory Structure
<br /> Type of Project: CI New ❑Addition ❑Remodel El Repair ❑T.I. El Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> Ccy P 5 Novc-/r.9.ce— 517eVide. c- ,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ME.0HA1;1174:4,P0#41'T' 104# .0tiONf '> .,Y'.` `,, PO B N“0.0 4. # L10.00.
<br /> Fixture Fixture Fixture Fixture
<br /> List of Fixtures List of Fixtures ist of Fixtures Count List of Fixtures
<br /> Count count Count
<br /> A/C—Air Handling Units Gas Piping Backflow Pr enter(Inside Bldg) Showe Tub,or Combo
<br /> Boiler Gas Range Clothes Washe Sink-Com ercial(3-comp,prep,floor)
<br /> Clothes Dryer t Pump&Ductless Dishwasher Sink-Residen' I(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrig tion Drinking Fountain Sink-Utility,laun ,mop
<br /> Exhaust Fans(Residential) Commerce entilatior loot Drain Toilet
<br /> xhaust Hood(Type I) (Not Heat/AC s m) H e Bibb Urinal .
<br /> Ex'- st Hood(Type II) Water Heater Inter ptor-Grease Waste/Water Piping Repa
<br /> Exhaus sod(Residential) Wood Stove Interce or-Sand/Oil Water Service(behind meter
<br /> Forced Air S -ms Other: Medical s Water Valves or Fixtures
<br /> Gas Fireplace/Ins-• Log Roof Drains Water Heater
<br /> „SPR NKI ER i SU ESSIONsPSTEM,4:,,,,, , Sewage Ejector r 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 I am authorised 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 /> eL 5 (q07 -oo0
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) 11
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