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grrPERMIT APPLICATIOI— <br /> BUILDING/MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ((E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1b 91V EVER,& Mail W.4 PROPERTY TAX#:OO j8120i10I1.00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Ros,e0 od-icuegitswaettus TENANT BUSINESS NAME(Commercial): n net 1y)an <br /> OWNER MAILING ADDRESS: STREET /22p7(() ( � /Xt /1/y� �OO �r�gait?'CITY IIVYVC\ (J . STATE 40:1•''' ZIP li gVll <br /> OWNER PHONE: 7� -le 629W OWNER EMAIL: <br /> CONTRACTOR NAME: 1--i -L,-,-(41-1,4- Y'QR.1 infE5/' - <br /> CONTRACTOR ADDRESS: STREET 076 &T/51A, ��ol 5r"- <br /> CITY 5601. �,, STATE LA)/ 6 0ZIP 9 V/yl5 <br /> CONTRACTOR PHONE:W (1 ✓ )/C4) CONTRACTOR EMAILCIU CLitGej 4+1 .i <br /> CONTRACTOR LICENSE#(REQUIRED):AG , 9 i L., CITY OF EVERETT BUSINESS LICENS _1r ` k <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) `(�✓^ <br /> CONTACT1NAMF: CONTACT PHONE: °J 0(p ��04 j <br /> (4 %R- X CONTACT EMAIL: 5 / (. 1ed�CP-aAi` .-6- <br /> e C <br /> BUILDING INFORMATION <br /> Existing Use of Building: .X"CLO.Q Contract Price of Wo <br /> r <br /> Proposed Use of Building: COrsifftQ,J('f Heat Source: ❑G. DElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Fam,i_ly--#Units: commercial ■•ccessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. LrrllSiign OSprin er ❑Demolition AChange,off Use <br /> ✓ <br /> DESCRIPTION OF WORK: ilnSlYha.�0. s csF tr)!jet) ill m ni r,4 • ,./, •, / t �, to 3e�On <br /> crotaw o Aka . R.1 firot ntL <br /> ASSOCIATED BUILDING PERMIT#(if applicable): il v \O' _o k2 • <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Fixture Fixture Fixture <br /> Count Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—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 /> SPRINKLER/SUPPRESSION SYSTEM 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.I am the owner.or l 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 /> �p City of Everett Official Use Only <br /> L�it� PE IT# ns _ „ `3 <br /> Owner(*:: ;)e:--."--"--- <br /> horized Agent Signature Date (Revise /1 /20 8) / Ywl <br />