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iNNO PERMIT APPLICATION I1I
<br /> BUILDING 1 MECHANICAL/ PLUMBING/SIGN J !IJRINKLER/ 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 Only Please .. .PROJ 'SITE IMFORMATVt! >.., .. ....' _� ,.. .a . {,.....,. .
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<br /> PROJECT SITE ADDRESS: p2 g,O I 3CC4Sic-ei +. C. t e,4—e. + PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> .... _... .:` M. .. ..< .. ,Z . ._.. E« � ,..tOUT;iI011:0ORIYY01:pla 1nn _;_W ,., .o .,. h O.
<br /> IAMEMY
<br /> OWNER NAME: ?rCN-Y 6. 1 C <`+f ?1 A TENANT BUSINESS NAME(Commercial): PrG Gti. c-
<br /> OWNER MAILING ADDRESS: STREET `Z�Q F--66-r I 9 S ÷-� `U►1AOC
<br /> CITY r1-2 C+LS ✓ �� • CA--- cc STATE 11_� " ZIP 2J/eV
<br /> OWNER PHONE: 'Yob 6,0808 ` e ! OWNER EMAIL: 4L\..._ C-cT`S r t l tr:P/1 i,r �``r , c...0Ni
<br /> CONTRACTOR NAME: e.\V-NeN 0,-Ks ( LL (..— '
<br /> CONTRACTOR ADDRESS: STREET (Ai"4Di S±6-4e-A.ie.....
<br /> CITY 'Vie,(---i4\,' i I L STATE i� f ZIP g 7
<br /> CONTRACTOR PHONE: 4,15 -1.Li — O+ `[j� CONTRACTOR EMAIL: A65-0 .toc\v^'���t= one-
<br /> �ko -t -5' C 6 1/14
<br /> CONTRACTOR LICENSE#(REQUIRED) 6 L i e i.407_,,..,,,,:,.. 27:,:,,,,,,2 P('" CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)oS3 7 411 11
<br /> PRIMARY CONTACT: ❑OWNER E CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4t .--) .'yoI L J l'
<br /> f+. Ol r 1.c_A-CSG_W CONTACT EMAIL: GCA.rb.r1�bei c,.C- .Ip"/y_,5" , ..en(1,"
<br /> r. ,a ,£ .,. KR � .p. v ... ...3BpUILDIN.G,INA ORM ION" f,.,.,..�. ..,..... .n�.,.,_ .#S �. ,s..., . ,`
<br /> Existing Use of Building: Coiv'c-" c"G c ciN (a nakfre a t Contract Price of Work:$ /Of ©b CD
<br /> Proposed Use of Building: S 0....0/\•e---" Heat Source: ❑Gas CI Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Additiontemodel 0 Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: �' '1
<br /> t\.,-co to ' c�--) b I.A.;r 0t;�. c.Zc.,A
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL`PERMIT 1PPLI CATION . `-.,,.. .. f` ,..._ _.PLUMBING PERMIT 'PLICATION ,,
<br /> FixtureFixture Fixture Fixture
<br /> Count List of Fixtures Count List of txtures Count List of Fixtures Count List of tures
<br /> NC—Air Handling Units Gas •'•ing Backflow Preventer(Inside Bldg) Shower,Tu.,or Combo
<br /> Boiler G. Range Clothes Washer Sink-C. mercial(3-comp,prep,floor)
<br /> Clothes Dryer Feat Pump&Ductless Dishwasher Si'•_Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain ink-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(Residen'..) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Ins= Log Roof Drains ; Water Heater
<br /> SPRINKLER,I SU PRBS'Q,SION SYSTEM Sewa•, jector 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 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 I am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the Contractors La 18.27'.=4 -nd 296.200A WAC.
<br /> / City of Everett Official Use Only
<br /> 84/ ct PE #
<br /> Owner/Authorized Agent Signature a6— ; L L Date (Revised 4/15/2019)
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