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imi PERMIT APPLICATION 'I I <br /> BUILDING I MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ 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 I www.everettwa.gov/permits <br /> (014:41011*IiiilAk Rilii*: 0 .: ... PR0, EGTIONIM NFORMA `IOI ....., N.... „ <br /> PROJECT SITE ADDRESS: '3() Gf� ,it/lo_410,j AM/( Wilk/ PROPERTY TAX#: ` 01"j I 8040 2.2-00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. / (attach copy of long legal description) <br /> CONTACt >INI'ORMMAT„ION <br /> q <br /> z <br /> OWNER NAME: iqrj K7144 TENANT BUSINESS NAME(Commercial): 5rO,f pq <br /> OWNER MAILING ADDRESSSS: STREET 4_ care i/J2q (A) <br /> CITY STATE 1 II3 - ZIP .,e6 <br /> OWNER PHONE. OWNER EMAIL: • <br /> CONTRACTOR NAME: i f- . . <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: \"k OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: <br /> CONTACT EMAIL: <br /> :'...,. BI 10$11NOT I FOR M11Atil.,0N ......a <br /> Existing Use of Building: (14,E� e_ rc, N Contract Price of Work:$ 8-'677t) <br /> Proposed Use of Building: 6VY,t r-fec?f Heat Source: ❑Gas Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition CI Remodel El Repair K.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: vc.f4 Vrewn 1960 rylike//0--- y'.vA v a-Vogl, <br /> ti J.' <br /> ASSOCIATED <br /> BUILDING PERMIT#(if applicable): <br /> MECHANICAL,. <br /> . � z <br /> pERMITA�!P14C4T1ON '- _. , . RL0NR#INO,PERm1'T pPPLICATIoN, ;... :. <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 Ventilation 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 /> int_SPRINKLER I SUPPRESSION SYSi tEM Sewage Ejector or Sump Pump Other: <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 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 /> City of Everett Official Use Only <br /> f"CD(/)'DI, PERMITVI <br /> ),1 !0%) <br /> Owner/A g t Sign tureDate" (Revised 4/15/2019) !k",,,,, <br />