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milIII PERMIT APPLICATIO
<br /> BUILDINdfMECHANICAL/ PLUMBING /SIGN�iIRINKLER/ DEMOLITION
<br /> EVERETTCITY 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 l www.everettwa.gov/permits
<br /> {Bi-i>e>o Blac.In1C Only Pleasalt< ..... ..._, .JEC 'Si E NFORMATl 3 °. �,.. ` _ �',.._.y...j 3.. ..w.`.5, `,> .., .. . v.m,, _ ,..a.
<br /> PROJECT SITE ADDRESS: 59 t to Viet-) R iose- by iv( >-vi edit 98203 PROPERTY TAX#: O0606 10000 73 ek7
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> OWNER NAME: &A 1z,ti i-, ' Gk Solt) TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 54 (0 U1 et,,) k)t q. b1? , I ,/�
<br /> CITY vi Vey?,'( r STATE VV Iq ZIP 41 Q e
<br /> 2-6,
<br /> OWNER PHONE: 412 5--2-S 7-®t 1 OWNER EMAIL: gci Y I\e,c`CSopil - coo,cosT't A-er
<br /> CONTRACTOR NAME: CAaT41Z Cacti STP^{t�)G" 10/0 1A)C, •— JV K� Cel2,T�
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<br /> CONTRACTOR ADDRESS: STREET 1 0 , r7� ke ce. (1e r P.v--e 4.
<br /> l� CITY E ve Y(_ ft STATE LA) Q
<br /> 4 ZIP lD�j
<br /> 2 D
<br /> CONTRACTOR PHONE: 1t2 ,- 23 S"-'706 L CONTRACTOR EMAIL: CG 1-Tc O®e Y011TIcr //(J,,�,''
<br /> CONTRACTOR LICENSE#(REQUIRED): CA 1 TG et c313 #(
<br /> CITY OF EVERETT BUSINESS LICENSE REQUI (O
<br /> D): 20 I55Z3_,9
<br /> PRIMARY CONTACT: VCOWNER 0 CONTRACTOR 0 OTHER(Please Specify) 3 /_
<br /> CONTACT NAME: CONTACT PHONE: L} Z S-Z 5 7-d 1 9I 1�a
<br /> 12.1L , JlaC.)CS®et) CONTACT EMAIL: C3cievJIjAckSOA)®CoiyiesST, he-
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<br /> - i Z 1 iE S 2 i
<br /> Existing Use of Building: S F R. • 16 %TC NC-Q ketAobri Contract Price of Work:$_ bar) +' 1 012 — $'!5 a/
<br /> Proposed Use of Building: 5 I\ - k 1 TL)F A- PAM L Heat Source: ' .Gas ❑Electric ❑Other
<br /> BUILDING USE:'gSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory S ,
<br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: 1 eil►'ia,e eqs-r to 6 CSS Stak JA tA�/Cc $ A. 1=(x7 rS
<br /> ihiSTA LL NEk1 WATER Si+uT of; Fork R. 12e-ea vse '4-tor. IN5T &c FU T-
<br /> CAS ".
<br /> To Re 10GfTLC a cook-re, fpr i tJSTAL( FAN ftDo p,uj? ye/VT/41 6, TO OUTSIDE WALL,
<br /> tP$TAI,tap ) 4INb ftPPZPr", 4S. t
<br /> ASSOCIATED BUILDING PER IT#(if licable): A c.log
<br /> _i ,�YIECi}1 N1CAL ERMIt40014C VAI .,,,,,,,,,-.,-P, AMB.. ..,,ER1111.,#1PP41C. .1.. ! .,,.. .
<br /> Fixture Fixture
<br /> Fixture List of Fixtures Fxture List of Fixtures List of Fixtures List of Fixtures
<br /> Count Count Count Count
<br /> A/C-Air Handling Units i Gas Piping-CoeKTOP 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 I Dishwasher t Sink-Residential(kitchen,bath,bar)
<br /> • t System(Remodel) Refrigeration DFinking Fountain Sink-Utilityflaundry,mop
<br /> A Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet
<br /> aust.Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hoed(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> -
<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 /> `' SPRINKLER I SUPPRESSIION;1 SYS`FEM Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System +No.of Heads ( .4 SI" FOR f ILIDA
<br /> Chemical Suppression System No.of Heads. .43 (WA fe1Z)
<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 /> S City of Everett Official Use Only
<br /> 9 ,- $II d (q PER \61Vg , . O( 2..
<br /> Owner/Authorized g n uy,nature 1 Date (Revised 4/15/2019)
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