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_I II PERMIT APPLICATIOI- <br /> BUILDINC�FIVIECHANICAL/PLUMBING/ SIGN I UI 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE ADDRESS: (067 • ever W <br /> - Mat 4 Y #Q PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _ ✓ ,......zi � i- - ... .:_ m ... _. >. u e - . ..O ,�.��+ �- ,v Y 41llW. x I -: `r .}-f ; y i -v , a W <br /> OWNER NAME: _ TENANT BUSINESS NAME(Commercial): He y j~Q,- %Assa c.. <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 612:ET' Slgr) erN/LCeS <br /> CONTRACTOR ADDRESS: STREET 16= [3O-}he,JI e&rek1- Hwy F'a39 <br /> CITY 1 ,1 C LeK STATE \A- ZIP CIO 01 <br /> CONTRACTOR PHONE: ffas' 330 8/bO CONTRACTOR EMAIL: -kDb±S I 5-L (MSn,Corn <br /> CONTRACTOR LICENSE#(REQUIRED) f313T <br /> _S q 9O CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): (��5 1 0 _.. <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �raylK !�� CONTACT PHONE: qts.330 /470 <br /> CONTACT EMAIL:„ . ._ ._..N. , A Ki. <br /> bbf5I n5 sfl ,C'ettr) <br /> . j _ .__._ .. ,.;* IN INFO MA1TIEO.N V <br /> ._. 5-r ._._ o ._,� >, ._ ._._-, . __ <br /> ) <br /> Existing Use of Building: Cy)dr)IrryCI4 � Contract Price of Work:y$ 158 5 <br /> Proposed Use of Building: ban/. Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: LINew ❑Addition ❑Remodel ❑Repair DTA. Rpign ESprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1\ LED S e a l lcLt( <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ,*(4.,^":0441* .i R: .1T*APIl?" 4** Enigiglikg,04.****0**0001001044.4AMOV <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 /> -4'.«,, ..SPR1N»� $007 ESSS.. � Nri A,,,,, Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEMENT:1 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/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 /> tie 17, iq PERMIICc\v 2.:00 <br /> Owner/A. ,. . A.ent Signature Date (Revised 10/10/2018) <br /> �/7 <br />