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® � PERMIT APPLICATIC
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<br /> BUILDIN1�1�IECHANICAL/ 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 /> {MWlue,or Bla*lnMi Only.Please), ,y, . ;y. <PRO;JECT SITE INFORMATIONatit ,.. ;. . ..., a .. ,<.A„ , ,..... ...
<br /> PROJECT SITE ADDRESS: .Suile N,, 3c‘-• sc evere.- Mold U.)0,.,t 'PROPERTY TAX#: ??.057106 Sot/300
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> d ;�.,,,. ,- � .- ...: �+r��tA�"1���I�FQR�M�ATICI�..�. M.- .. _ . ,.., ._.
<br /> OWNER NAME: 61 M Pkt,16t, 40A, tie TENANT BUSINESS NAME(Commercial): 51 c3JVlq. YY14
<br /> OWNER MAILING ADDRESS: STREET all L( ,V r �f48( v I
<br /> CITY 5�GCGt`e- Ce if'STATE CZIP 9 l 6,o(
<br /> OWNER PHONE: & q) bo 7- 77 OWNER EMAIL: Y /Cox Aico V1
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<br /> CONTRACTOR NAME: ,....--
<br /> t if tome.- 1�Ov (jRQ144I'1Ots)&t -e. 1 - Vt� 1--I2CAD
<br /> CONTRACTOR ADDRESS: STREET L(Q 001 ` dr-N-- 'hR s 6
<br /> CITY M 1 it ( rA J STATE w A- ZIP 91101 a
<br /> CONTRACTOR PHONE: 4906-fo3(p _. l a I S' CONTRACTOR EMAIL: a Lcand cLohA 0.®') INtCi4' I r co W)
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIVRED,):.(�A-' =Z
<br /> PRIMARY CONTACT: 0 OWNER %CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> BU,O:,NCI,7000Rt111AT1,01+1
<br /> Existing Use of Building: C I Contract Price of Work:$ LI,f 9Q
<br /> Proposed Use of Building: C." I Heat Source: Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU 0 Multi-Family-#Units: (commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair X''r.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> oVe- s —gt- 1 v1�=ntbr 001)-bbl
<br /> / 2,14 awl- Zw�pr�v�n d� �ce�-a`�-- S�x�c� . t
<br /> tAa td su. i wefoLAs c*JA yrs'. Cot),s-ro c k cert a re0111 / b mrile 044^a To"-be4ncr,
<br /> ASSOCIATED' PERMIT#(if applicable): p�dT dz'n-i u\ t it S,
<br /> . ,MECHAh11CA ORMit:000:0 100 ... ,1 <, } .n _... .. ... .ti M1 BI1 +0ORMW 141100100.
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures count List of Fixt es Count List of Fixtures Count List o txtures
<br /> A/C—Air Handling Units Gas Pipint Backflow Preventer(Inside Bldg) Shower,Tu ,or Combo
<br /> Boiler Gas -, ge Clothes Washer Sink-C mercial(3-comp,prep,floor)
<br /> Clothes Dryer He- Pump&Ductless Dishwasher Sin esidential(kitchen,bath,bar)
<br /> Duct System(Remodel) -efrigeration Drinking Fountain nk-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/ og Roof Drains Water Heater
<br /> ,-„ry SPRINKLER IF,,;OPPRESSION SYS`1'EM„ y r.,. Sewage Ejector o bump 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 perforin the work for which application is made,
<br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> aa-©4-- PERM/c rJ - 0 Lk (
<br /> Ow r/Authorized Agent Signature Date I (Revised 4/15/2019)
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