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1111=1 ��j�� PERMIT APPLICATI <br /> ni <br /> BUILDINUTIVIECHANICAL/ PLUMBING/SIG= <br /> RINKLER/ 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*Black Ink O ly�Please) ..:`. PRJE <br /> OCT-SITE INFORM 1T ONh..... . ...... ..a. .,. �.... <br /> PROJECT SITE ADDRESS: !o f 14 tI /4,14 ✓J EVeir j? PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: C` tVerrik TENANT BUSINESS NAME(Commercial): 1/0((U <br /> OWNER MAILING ADDRESS: STREET 2?30 t444r Qvc 4riff °u <br /> CITY EE(/m STATE (/1/4 ZIP /92_0/ <br /> OWNER PHONE: 5-1 ( acct OWNER EMAIL 4- averw. ', d,, <br /> CONTRACTOR NAME: Cay% (ge 6,efe ,[. <br /> CONTRACTOR ADDRESS: STREET 29)0 LA4(yv4,r4 4 trf <br /> CITY ve4-0.-'f- STATE 04,4- ZIP /520( <br /> CONTRACTOR PHONE: 5125 3 Za 4'ts CONTRACTOR EMAIL: jeviG.`f Q &c- y' <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: a OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '/2S378 '6s7 <br /> —1°4 d lei`( - Coy oi?Gvy,, CONTACT EMAIL: f nc.,l e e‘,€., , ,A, <br /> OliMeRiAilalliiWitNFORMAT10W .D5REEWMENERTEMain'itiME•isR --7-'t- <br /> Existing Use of Building: Cm, 4.7.„ Contract Price of Work:$14 - 0.- <br /> Proposed Use of Building: Gun R‘,,,,, Heat Source: ❑Gas 0 Electric POther 0 <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: El Commercial PAccessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remode l El Repair Cgr.i. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Zns-4 I/ a' c‘,i- c-A ,, cm Der.-tL eery 09,0, u <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANIC�.AL PERM!T APPLWATiOl+t ... <br /> ,PLUNIBINOKPERMIT APPLICyA'fiON: . .. ..... <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <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&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 Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLERI SUPPRESSION SYSTEM, `, .; Sewage Ejector or 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.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 /> P.5-71-7ERhQIT#��O - 00• <br /> er/Authorized Agent Signature Date (Revised 4/15/2019) <br /> V2— <br /> Z <br />