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I PERMIT APPLICATION
<br /> BUILDIN_-CHANICAL I PLUMBING/SIGN" =RINKLER/ 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue*Back IPKVAy P1tease) ` .. .I.:rI,.PROJECCTSITE INFORMA;TIOt3N.,, \ k - .;..,,:'*.,.. , . ,, . ........ ... ..
<br /> PROJECT SITE ADDRESS: t1 J g r 4vt ev kiP PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision /'�/�, Lot No. (attach copy of long legal description)
<br /> ig 1. ._,. P. . ,..,,„CONTACT INORMATItl �., ' . _ ,, g ,.
<br /> OWNER NAME: fV1 R- -i "L,,) \- t,c . TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET i LA'1,03 Su;in v1 S 14 Q .-•f C.. kA
<br /> CITY S L l STATE Lk) P` ZIP 4)<X, 13 3
<br /> OWNER PHONE: 1195( rrDO t .� . OWNER EMAIL: oee4116'/cls F,L �
<br /> mice f/. Ccw
<br /> CONTRACTOR NAME: �-z.el . u coil rC`Lc A, j I- C,,,
<br /> CONTRACTOR ADDRESS: STREET 0 7 5 /-)ri(/' k-.1�1
<br /> CITY Post- Fee //S / STATE I P ZIP qj s°,5--/
<br /> CONTRACTOR PHONE: 30 " T2)1 — 1/OC61 CONTRACTOR EMAIL: Jne,y'l task cet")hrztC` ' (a`troir::—.,.
<br /> CONTRACTOR LICENSE#(REQUIRED) E L.L. f CITY OF EVERETT BUSINESS LICENSE#(REQUIR I �� it 11
<br /> .,sem ». .< ,
<br /> PRIMARY CONTACT: iirOWNER 0 CONTRACTOR 0 OTHER(Please Specify) —_--/
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> UILDIIv aANFOR A`ION
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<br /> r h= ... ,,> ... ,. ,.. ., c5++., S , x .,..,_r, n �,r. „v...� .,saa,. . >$ .,_. _.�.s,o ... ..3„
<br /> Existing Use of Building: DV I- c -r 1, l-t iv\ 'c f,.Contract Price of Work:$ 13C- CO c2
<br /> Proposed Use of Building: 5 }-{ }- j_5 FI-t iv. ba(k.Heat Source: ❑Gas utlectric ❑Other
<br /> BUILDING USE: L2/FR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: EI Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: P4..4 rn 1�I 1q f� /r t c'on 1 I\ .le al d,4 ie X -o 0t. �.p�,.i-gfM i
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> s MEDHAN1CA1.**01 T APP.LIC+A 'IDR..1i, . , , . . ..,. _.. fitsi.P I-CATION,
<br /> ,. , t �..` ': PL`tJllrlBl ERI41�T APP � . ,,. -;.
<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) 1 Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer _..... Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless / Dishwasher 3 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 /> i 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 /> `, . SPIRINKLER 1 SlUPPRESSION,SYSTEM ,,,,, Sewage Ejector or Sump Pump / Other gA, y dv I i'r._.
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System I �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 lam 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 /> PERMIT# C-1,4-1 ( Q (t5 CO ,
<br /> Owner/Authorized Agent Signaturg' ate (Revised 4/15/2019) V
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