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17111 PERMIT APPLICATION I II II
<br /> BUILDING AllikCHANICAL/ PLUMBING/SIGN /SPRINKLER/ 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 B1a.I kc,Ink my Plea )t ' 5 tl t.E PROJECT ITE,,IIsl ORI A71O' �', .. ` . ,a,a,,.. ..< ..., �;. ..,,,. » . ......
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<br /> PROJECT SITE ADDRESS: 3G 2_. COC....g y ,C1).4r,6774 IA j il PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: '3(:)(5‘ (QC„ y )lL TENANT BUSINESS NAME(Commercial):VV V\(A,w -0
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<br /> OWNER MAILING ADDRESS: STREET /86� ✓N1(,(J.C,,i 77 lC1 0(f ----
<br /> 144/ (2i 1 L(ZCITY C STATE (,04- ZIP 7 'ZO (
<br /> OWNER PHONE: 6--"'SIO--2-5'f OWNER EMAIL: ,M 4 ," 4' 1,52- ,,,,—C.D,c.) /,('(j
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<br /> CONTRACTOR NAME: PUK---5 r-7-7IJ51 UCt nt
<br /> CONTRACTOR ADDRESS: STREET A/OK 1✓4AI k.i_ . q(UC A)4.-
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<br /> 4-MVV ys(J1 t L CITY STATE GOA— ZIP X7_'7/
<br /> CONTRACTOR PHONE: 'z.46 SO Z5 C-i ^ CONTRACTOR EMAIL: Stq-rA :,
<br /> CONTRACTOR LICENSE#(REQUIRED): ► lir CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: ZLOWNER 0 CONTRACTOR 0 OTHER(Please Specify) D' rb 01 L\').(p
<br /> CONTACT NAME: AA 1/4.d21` t.G iv CONTACT PHONE: ZC 6 —SIO,.- y(g
<br /> CONTACT EMAIL: c'
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<br /> Existing Use of Building: (17-rvl .. Contract Price of Work:$ 32/C2f20
<br /> Proposed Use of Building: ,( k) .i-ii,Vi 6.0 Heat Source: JZfGas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU El Multi-Family-#Units: El Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition ❑Remodel IgRepair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: 'KE.NlO 0.6. 8 - c( (A15 1E v.J-(() COJEf2 Rai4ef,
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<br /> FaL-Y 4bekite6D 1-730 F -7714. ki,✓-(-
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MEI:1410NII+ALPIRIYI:I,T AP.PiOATIOI+1,.,= ..<
<br /> ,1: 1Mt;AO*ffi,A.*(.0,10131003.***)(110#144:0110,NMigtnirga
<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 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(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 /> SPR:INKLER,I,.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 gr- ting.f a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building Official before being- ,..rized der.ny 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 I comply with the S S.c-- -cto•La. 18.27 RCW and 296.200A WAC.
<br /> ' City of Everett Official Use Only
<br /> ._______ Sd /-2-0/f' P L/ l
<br /> Owner/Authorized Agent Signature Date (Revised 4/15 019) )
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