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MINI
<br /> PERMIT APPLICATIOFL1.
<br /> 121
<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER I DEMOLITION
<br /> EVERETT E R C E T T CITY OF EVERETT PERMIT SERVICES
<br /> v 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 /> i yr, k�,N ' '�,' € n n a i i .'�+' �r � g`�"� *i i �-'�f3� t- '. s r�- .::- RayR. ��� � 3xa.
<br /> (BJue or Biack Ink On .Please ,ROJ�ECT S1TE*1N,FORMA O . '' � .,.su " ,r, i ,.-_ � .t
<br /> PROJECT SITE ADDRESS: i I Z0 M GDO61411 Avg PROPERTY TAX#: CJ ('e-f g07‘{Z o/l©D
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> W .r a 3... . CGONTACT INFORMATION. .y M g - ,K 4
<br /> OWNER NAME: (Ji1/11 i /1/7 of cr ,t,old ori r SA C4'4EANT BUSINESS NAME(Commercial): yity1 6/q Of h oAoars h
<br /> OWNER MAILING ADDRESS: p�ADDRESS: STREET 3/20 f G Do cr a q`/ A e, �1" fy
<br /> ✓&ve//f` CITY �J STATE (iV i4t ZIP 7820/
<br /> OWNER PHONE: yZS 37y 5-5-00 OWNER EMAIL:
<br /> CONTRACTOR NAME: -re p C 1.-`1 GeviS.v''1t;G `a iI Noq h 144,r n'N
<br /> CONTRACTOR ADDRESS: STREET 2-G v /i 2/17 c Ai£ S'r j c. PP G
<br /> CITY {-/te.U y .,e.- STATE (/t//9- ZIP ' oce,
<br /> CONTRACTOR PHONE: e12 5 5 I — q 9f L/ CONTR CTOR EMAIL: /V�I ti m L_ 117, c._,, h,.t
<br /> CONTRACTOR LICENSE#(REQUIRE CITY OF EVERT BUSINESS LICENSE#(REQUIRED) 2/52,z
<br /> ..� ..... . r ,� EVERETT r.. ,.. ....,. _..�.,� 1,
<br /> PRIMARY CONTACT: 0 OWNER ❑ ON T CTOR OTHER(P ase Specify) , -v h r'fcc,
<br /> CONTACT NAME: 3/2 4raa:14 .v-C, CONTACT PHONE: 1/26" . 6 2—2/53
<br /> DOt rz/`t>//e Ow/. CONTACT EMAIL: ,;,,hi e..,//e.e2g12Q,-G�,X.ci v- a cow
<br /> Z:. 3 _ tg ti < . , BUILDING INFORMATION g ,v E .. 3rxM,,, .
<br /> Existing Use of Building: I 4i'1-1 GAS5' Contract Price of Work:$ 2 i 000
<br /> Proposed Use of Building: i z .41A-t e 5 Heat Source: OGas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: gCommercial ❑Accessory Structure
<br /> Type of Project: ❑New EAddition ❑Remodel ❑Repair NT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: '7/ 76,g s. L /,,o///.Gyy•d✓' re pp-soII/ ..'f 7 /9 c�22 5:F,
<br /> `/
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECH,ANG4U. PERMIT APPLICATION ;• ,, ,Zu,A Pt UMBING.`PERMIT, P .KATIONMEW
<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,o _• bo
<br /> Boiler Gas Ran Clothes Washer Sink-Co•' -rcial(3-comp,prep,floor)
<br /> Clothes Dryer Hea ump&Ductless Dishwasher S. -`esidential(kitchen,bath,bar)
<br /> Duct System(Remodel) efrigeration 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(Re i ential) Wood Stove Interceptor-San. Si Water Service(behind meter)
<br /> Forced Air S ms Other: Medical G_ Water Valves or Fixtures
<br /> Gas Fire ce/Insert/Log Roof P -ins Water Heater
<br /> aa _ P LERv#P3SION YSTN1 „ t :ewa e Ejector or Sump Pump Other:
<br /> Water Sup ession 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.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 /> //a/Z-2-t e...--7,C /31-4-1 ‘----Z-- 7//6//? PETEE# " otY 5
<br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) ,...,
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