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Nisi PERMIT APPLICATIC . <br /> Lomi <br /> BUILDItVIECHANICAL/ PLUMBING /SIGtPRINKLER/ 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 /> {Blue,or,Black Ink On MPhasew• „,_ a•• ..,PROJECTaSITE INFORMATION, ,,, , ._,•„ ,, . .. , <br /> PROJECT SITE ADDRESS: 20 J 6x=6L xr bc PROPERTY TAX#: tc/4°06 rg <br /> LEGAL for new construction •Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> d <br /> CONTACT).4FORMATI©N <br /> OWNER �} TENANT BUSINESS NAME(Commercial): 2 VVIE ' sf 4- e <br /> OWNER MAILING ADDRESS: STREET 41130 t) 1A)1 'C l ( P <br /> CITY V STATE ZIP 9 g7.4,--1 <br /> OWNER PHONE: TVG --%-"I O —'I (U OWNER EMAIL: `4 W S LaMc QST— Nth <br /> , <br /> CONTRACTOR NAME: tOce lea Ti Iec i <br /> -to p-) <br /> CONTRACTOR ADDRESS: STREET PO RiNI6 l 'O <br /> CITY gd NiN el <br /> wC STATE LA)P- �ZIP 9 "�/J - <br /> CONTRACTOR PHONE: 75-3—' 17 'CONTRACTOR EMAIL: te FC a 1c(E'-.1 iZICry'\ <br /> CONTRACTOR LICENSE#(REQUIRED): 6(A C(riz:. <046,z- <br /> CITY OF EVERETT BUSINESS LICENSE#(REQUIRED,ata22— <br /> warn <br /> PRIMARY CONTACT: 0 OWNER IrCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2.-S-'3 — ( --...-7 —S--55 • <br /> ,,\cp,y,E \,)P' CONTACT EMAIL: ,,SP< V. 6( p<ATP 4 TLf VN\ <br /> Existing Use of Building: ea0"-10"\ Contract Price of Work:$ t i 700 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ® . t tpN 4C 112 <br /> - 14C2- _epoi?ei__ <br /> J l7 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ` <br /> E . (IAE HI4NIGAL;RE# M T.00.1.ICATICQN ..,a., Pl.UMBINO.I EK141IiT PPIJC 1TIOM. . .r <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 /> SPRINKLER!.SUPPRESSI4 .. EM, ? ,._. I Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of eads <br /> Chemical Suppression System No. of Heads. <br /> ACKNOWLEDGEMENT:I have revi= ed this applicati• and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and I. = a The granting of-permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before,-mg a • zed under a ,circumstance.I am 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 t•-State C ctors Law ..27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> _� 6 /5.../1 PERMIT# vqq3 ..... oo cl. <br /> Owner/Authori -d-•gent Signature Date (Revised 4/15/2019) <br />