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I .. II '' PERMIT APPLICATIc 1
<br /> BUILDING7MECHANICAL/ PLUMBING I SIGM'SPRINKLER/ DEMOLITION
<br /> E V E R E T TCITY 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 ar Black[nkOnIy P easel., ._.s. .,. lid'RcWEOT,sItE IfrNFORMAIISIf_.. ,. . ,., ._. , ,3.., ..,.... ,, ,....,,_,-
<br /> PROJECT SITE ADDRESS: 6 P.00 j U-S-f-\c S4-cc-e(- PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> . , f , CONTACT INFORMATION .,3_ {,;
<br /> OWNER NAME: - x . _. .;
<br /> (6®COI MOv•_P C--r'oc p TENANT BUSINESS NAME(Commercial):fbe)(OO-5i1r1_QiEjTC9- --
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<br /> OWNER MAILING ADDRESS: STREET \D ® i 1" �.cs+C1 St
<br /> '' `` , CITY CU-Q-r�C...- 1 . l STATE LViL l ZIP 97,9)2\6--
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<br /> OWNER PHONE:"l/ G--{,0 r--GI&k-to OWNER EMAIL:
<br /> CONTRACTOR NAME: e r\ I (It.(7 105
<br /> CONTRACTOR ADDRESS: STREET (`IP C C ( ,S(4.-
<br /> cry Y --e(A_A- STATE LA) 4- ZIP 9A63 iW(// n 1
<br /> CONTRACTOR PHONE:00(0)-no-9,_d4O CONTRACTOR EMAIL:A-C.-C,OI/.V1 IIA
<br /> :.j �€ tC_C Y\ °t 11
<br /> CONTRACTOR LICENSE#(REQUIRED):b , _t'� c2 v e t v.5 CITY OF EVERETT BUSINESS LICENSE#(REQUIR 0 K
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<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Speci )
<br /> CONTACT NAMES�r^�� -� S CONTACT PHONE: r o lo+ -qc �,�J 0
<br /> CONTACT EMAIL: N '. m.� tI k 1 Ve o__ v C C
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<br /> Existing Use of Building: Contract Price of Work:$ 3 t 7 c
<br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: T I,IA tbc�Rk >- s iv,4 $covet O C(k.Cj t COe iNk
<br /> \-O ab©v.-4- c9,0‘-qi p p\ ole jam- tt S acne( -e - i):
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ME0tIA1Iy ►L PERMIT *100.ATICQId„ •
<br /> . ..;;.PLUNIBI14�'ERI111i'TF#IIFLICAT[CIYSI; .,.. E . .. ,.
<br /> FixtureFixture 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 1 Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatior 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 /> ';'}I.W:tipititott-tk•i****10:01-40t SYSTEMN ...,r Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System No.of Heads.
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<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 . stance.1 am the owner,or lam authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the State Cont. ors Law -CW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> '.41# ,.--'
<br /> PERMIT
<br /> r II Ic.) ___... Dcf\
<br /> ,owner Aut orf 1Zed . •ent Signature Date (Revised 4/15/2019)
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