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PERMIT APPLICATIO.■ •
<br /> ILI
<br /> BUILDING] IIIIECHANICAL/ PLUMBING/SIGRINKLER/ 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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue or♦Black iiii;6 ly Please) ;PROJECT SITEINFORMATIO: v = £.. N v H ,...... :.,
<br /> PROJECT SITE ADDRESS: 3(Lc 12j , j4ve„ 1305 A PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ,. CONTICI,INFORMA'flO*r . '`, , ,
<br /> OWNER NAME: 14(9L)611, (-bpm TENANT BUSINESS NAME(Commercial): 61 k' �lv►N'Il1115
<br /> OWNER MAILING ADDRESS: STREET 5--(6 NO 6vet.9rev V ii y
<br /> CITY j U PrP-41. / STATE /AA ZIP -14 214
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<br /> OWNER PHONE: /)._ 11 OWNER EMAIL-•13�I OG I-.I di, 'n 4,0 r l7r�.
<br /> CONTRACTOR NAME: Aril i(
<br /> 6 ((i(p.0( [pd1s4--,x: fih McOLi Z tt .
<br /> CONTRACTOR ADDRESS: STREET 3( )...0 H-e4,),t,
<br /> CITY Ed e.,,,,4 (�' STATE 14jor ZIP .342e/
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<br /> CONTRACTOR PHONE: 1-12.5=151–te9S-1 CONTRACTOR EMAIL: kc.,ct[OJ e.,(Re c flied 691131) is ,jij
<br /> CONTRACTOR LICENSE#(REQUIRED): 12 EC,/4 004 OF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 2.,,
<br /> PRIMARY CONTACT: ❑OWNER JEI CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: /, – `7 40 .�tiq q3
<br /> �✓I I r 61.J6ttn5/If\ CONTACT EMAIL: �J"7.ScjA es S'�1Yl e.','i,,,,,ko�4-6, -f%-
<br /> Existing Use of Building: (00 iloapitie, WI 06/413401.99Contract Price of Work:$ I0
<br /> Proposed Use of Building: ,$I4 A Heat Source: ❑Gas NIElectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse 0 Duplex ❑ADU g,Multi-Family-#Units: 6 ❑Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition 0 Remodel 0 Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: .' y,9 1, r,P sal X 5,f � .�. r°•Rt jf �4) - -hN �� kL s .
<br /> i c� L. 1 1-: S r►1 V5 3 64 WreOi 5 i`rl 4- i +o.lek i ",644.1( 4s* p;gln Aik,414.44-- i(tie
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable): 8140'7 o)2.i-j
<br /> MECHAiI 0- 1PERMIT AP.0:00. ,10 . . ..... . Pl UMBINO.PERMIT APPLIBATIO ..
<br /> Fixture Frxture 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) (0 Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless fa Dishwasher i'1_ Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> (jt Exhaust Fans(Residential) Commercial Ventilation Floor Drain j, 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 /> /,y 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 /> ,' SP.RIINKLER,I SUPPRESSION SYS`fEM 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> I PERMIT# / ,0% I I, D I
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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