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PERMIT APPLICATION
<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (6.14i,4;Black Ink Only"P_lease}s<,. w, :°PROJECT,SITE INFORMATION ... ;.
<br /> PROJECT SITE ADDRESS: 1 18 '105441 P I SE PROPERTY TAX#: 0051-/c:P 6 00000 D7
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> ,, .t : , .. . -w _...; „ CONTACT.INFORMIITIOW ,." ';::::'.'i:,7:',,7:':',:.
<br /> OWNER NAME: f)asole. Sc erwerr o TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET1 (8 IDS P I SE gyp
<br /> CITY E Ue l w /
<br /> STATE fl ZIP 61 Q 08
<br /> OWNER PHONE: I (' ,, J OWNER EMAIL: /`'' ,n /��� / /
<br /> CONTRACTOR NAME: 'JGk F✓ue21218d f 114+P�1 fliee !.WI . ( f IlY�_ 5� uL,
<br /> CONTRACTOR ADDRESS: STREET ''/66' -OmLt) �j. 10
<br /> CITY Mo rrH kp r ce_ STATE ZIP C1804/5, �,�,,b
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: a Ie)c n (,' hoinecceecDrir� ie_.Q..
<br /> CONTRACTOR LICENSE#(REQUIRED): 6014 138153- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): `O
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<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) )►I I�-+--t©e- cSi( I'7 tic_,
<br /> CONTACT NAME: CONTACT PHONE: (4,95) %7^7'173 0
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<br /> Z�IhQ 11._ CONTACT EMAIL: p�Due�(, mail e CIM
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<br /> Existing Use of Building: Contract Price of Work:$ 15,DOD. 00
<br /> Proposed Use of Building: Heat Source: OGas DElectric ❑Other �'
<br /> BUILDING USE: XISFR ❑Townhouse ElDuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New EAddition ARemodel _l jRepair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK D/01,001.0 'rion ibcotbect el 1p Lit- O
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):Q V
<br /> MECHANICAL PERMIT APPLICATION PLUMBING'PERMIT`APPLICATION,.',:. ,
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Count List of ures Count List of Fixtures Count List of Fixture
<br /> NC—Air Handling Units Ga (ping Backflow Preventer(Inside Bldg) Shower,Tub,or o
<br /> Boiler 'as Range Clothes Washer Sink-Comm al(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink- Idential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain -Utility,laundry,mop
<br /> Exhaust Fans(Resident Commercial Ventilatior Floor Drain Toilet
<br /> Exhaust Hood(Typ- (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood 'pe II) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Ho.. (Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced • r Systems Other: Medical Gas Water Valves or Fixtures
<br /> G. fireplace/Insert/Log Roof Dr ' Water Heater
<br /> ` RINKLER"I:SUPPRESSION;SYSTEM ; S ge Ejector or Sump Pump Other:
<br /> W. " Suppression System No.of Heads
<br /> ' emical Suppression System I INo.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 lam 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 /> �/ „� PERMIT n
<br /> All/‘ /`2 - 0.3 / ' � �
<br /> Owner/Authorized ignature Date (Revised 1 0 018) /
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