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iimi 11�II� PERMIT APPLICATIOI��
<br /> I I LI Li
<br /> BUILDINECHANICAL/ PLUMBING/SIGN I 141•RINKLER/ 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 /> (BlueF.or Bllack MIs.O nl jr Piease):..f.. ,,,.. : .P ROJECTr SITE NF4RMATION y. ,.; . i Ngig4Sta.. , .»r»,» , . .....,. ,., >,.,
<br /> PROJECT SITE ADDRESS: 90a a. L./e,S L Q 1,v' 6�, Kt1ert 42,113 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision I Lot No. (attach copy of long legal description)
<br /> __..,,.,,. CONTAC""11NFORlf ATIOi(+I
<br /> OWNER NAME: A4:14< 139(c C TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET ,5q•fvt.v
<br /> CITY STATE ZIP
<br /> OWNER PHONE:N.,,,,,q 'c e) —c26'- OWNER EMAIL: rjge)( fi'0 CGr(, ,,� yln,`�� Co tr✓�
<br /> CONTRACTOR NAME: Cot�ey,<. e�t-1'vtJ
<br /> t�..qyl AL�
<br /> .�f, � .�.
<br /> CONTRACTOR ADDRESS: STREET 6- -'a,ti // +- PL g,4-1-) �^'
<br /> CITY 04..zi C f=+e0 STATE 1.4.-'/9. ZIP q ga J
<br /> CONTRACTOR PHONE: c 0$ 2 j j/ -rg,7 t CONTRACTOR EMAIL: C,rd. <im,i 3 g 9 rt.,►( •Cot,
<br /> CONTRACTOR LICENSE#(REQUIRED): CC. Co R EY,97q` s—a vU& CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER g CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: c70 6 ,2(3 -g-Ya t
<br /> C0 C 'P,)1 cim.11ArN CONTACT EMAIL: Cr j 5 , 3 8 q yvt,'s'r a , Cb l
<br /> <.. , . .BUILDING,IN!DRMATIO IE. S. . R ,
<br /> RE
<br /> Existing Use of Building: _ Contract Price of Work:$ 1 ar3 020 0 0 0
<br /> Proposed Use of Building: Heat Source: &Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial OAccessory Structure
<br /> ❑ ❑ �
<br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign
<br /> Sprinkler ❑Demolition hange of Use
<br /> DESCRIPTION OF WORK: ize. b U r1 b I d 0 r/ -c 1,0.e.,€.., .9Inc( r-e_p t: C,;%/1...)) i+{rt 9--,c
<br /> .'s -co{ Lej,- A i,r - ,ireY4c,e-, , -S l[rie cif -P,rrl,c9 .. , 9-( ,rezo.ciii
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> If004, 40104i#ORM T AP#I-.00jO(ka .., , . VA.., ,.g,' RI.I 0001 P010t `Ar#0 'x.0001
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures 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 t=ans(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 /> izifie0,100:KOK4:000.00:10100:011fAiN Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> •
<br /> Chemical Suppression System No.of Heads.
<br /> ACKNOWLEDGEMENT:l 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 State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> / -a J-aO Pim�' a — (Q5
<br /> Owner/Authoriz4.y.,,,,,,,,7
<br /> t Signature Date (Revised 4/15/2019)
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