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MN PERMIT APPLICATIO=
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<br /> BUILDING/ MECHANICAL I PLUMBING I SIGN /SPRINKLER I DEMOLITION
<br /> EVERETTCITY 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
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<br /> PROJECT SITE ADDRESS: all O l -RaftAve., EJecie t.j PROPERTY TAX#:CAS 171-55,94®3100
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> , . 'IFORAT
<br /> 1w.. . . . , , :23,, ` m .. CONNTA ' N ©N�w , d
<br /> OWNER NAME: 0 3\ TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET ,2 4 OH +toy -fhie_,
<br /> cm' J4 ( STATE ck3NC\ ZIP qaa© 1
<br /> OWNER PHONE: ,2 — —51 S ,� OWNER EMAIL: ar ar, i('" t CQUVA
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<br /> CONTRACTOR NAME: , l k C'�+l v` �In
<br /> Q. n e C
<br /> CONTRACTOR ADDRESS: STREET `
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 1-1,2 5.-3 '.q `1 !j
<br /> -5v .01/4. ®C CONTACT EMAIL: b, Ma Ai-e_,-Th a G OA. , CO V\
<br /> B JI DINGMi,NFOR'tMATION _...._ ;., . . .I ,
<br /> Existing Use of Building: Contract Price of Work:$
<br /> Proposed Use of Building: �� Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU 10/Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.'. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTal,ON OF WORK: Rem.6v)vw, GV\t
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<br /> --#1.(pi, S en *td ec e� so, i 1 54rte.. ` Ic.-iPne S avd tAe-, tub c_ �. e
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<br /> v✓c, ©r" t 5...10. ioA.•
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECH INiCAL PERMIT,*PPLIRAT,IO ., ,..£,. .PLUMB,NG,I ERMI E A ATI# .
<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 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!SUPPRESSION SYSTEM , a Sewage Ejector 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.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 /> j City of Everett Official Use Only
<br /> '7 i 5 l� / � PER I #��0 `_ Oi
<br /> •wner/Authorized Agent Signature Dat (Revised 4/15/2019)
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