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ILI PERMIT APPLICATIO* t
<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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> //Blue or Black tnk4On Peas`« ` W a " JECT SCTE INfp TIONS " .` Ek a�,�t ' �' : ` � " f
<br /> x u cO ci . no; f� .i 6 , �`y 00 S9 3 663 '�Ocx�C,i
<br /> PROJECT SITE ADDRESS: A// ,.s,' PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Sr„, 5 Lot No.6 7 (attach copy of long legal description)
<br /> 11311025MANIVELOM _` OONTAC`t 10:00RMATI01 Ars MA M
<br /> OWNER NAME:EVE 11—< � D+51" 2 TENANT BUSINESS NAME(Commercial): EPG S
<br /> OWNER MAILING ADDRESS: STREET__4730 COL, A,��,, 6'n` e•
<br /> c E(. F E STATE ZIP 4478;20" ,
<br /> OWNER PHONE: OWNER EMAIL: �ll���///
<br /> CONTRACTOR NAME: _ CIL' eU 6 1 VY l`c;e
<br /> CONTRACTOR ADDRESS: STREET I g- ,D til- PP (4)•
<br /> CITY JIn f WUn STATE A rV J-T/t• zip.1$O '7
<br /> CONTRACTOR PHONE: / CONTRACTOR EMAIL: V
<br /> CONTRACTOR LICENSE#(REQUIRED) \j (AL E far0,49 94CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 66339—
<br /> PRIMARY
<br /> J633PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ETHERPlease Specify) 2.
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<br /> CONTACT NAME: 1 0 r ' tK44� CONTACT PHONE: (4efit5 c?...52 94 ,_--
<br /> (.69450. & (j tfQt -b, r CONTACT EMAIL: p egegt Ztec_
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<br /> 3 f, rptnr , rUNGNFRATIO . r : 7a' ts
<br /> Existing Use of Building:C(p+,Aal—c.V•L Contract Price of Work:$ —7D A.
<br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ['New ❑Addition ❑Remodel ❑Repair DTA. ❑Sig ❑Sprinkler ❑Demolition ❑Change of Use /y�
<br /> DESCRIPTION OF WORK: 1� 1 (t 4ftJ �µ(f .' Ti'i —�" 'E /f .e
<br /> ?kJ-Pcbc,‘",:ts&leeA4..... iis.,..., coetfL -to tot Je v•Ao risLod eapcc_cavA Lo-tt
<br /> ASSOCI�A ED BUILDING PERMI # plic ): WIN^ f (24 •rw4h1 I&
<br /> MECHANICAL PE,RMIT�APPLICA ION _.`P,LUMB(IG':PERM,IT APPLI„CATION, , '
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Fixture
<br /> List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> CounNC—Air Handling Units G s Pipi ig , Backflow Preventer(Inside Bldg) Shower,Tub,or Corn'.
<br /> Boiler \ . -ange Clothes Washer Sink-Commercia -comp,prep,floor)
<br /> Clothes Dryer eat Pump&Ductless Dishwasher ,ink-Reside '-I(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain ! nk-Utili laundry,mop
<br /> Exhaust Fans(Reside tial Commercial Ventilatior Floor Drain I 01 vile
<br /> Exhaust Hood( p- :,r (Not Heat/AC system) Hose BibbU• al
<br /> Exhaust Hood( ,`„, Water Heater Interceptor-Grease ` Waste/Water Piping Repair
<br /> Exhaust H•`e•1t-,-'dential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air lb :ms Other: Medical Gas Water Valves or Fixtures
<br /> Gas Firepl /Insert/Log Roof Drains Water Heater
<br /> 'SPR1. „ LEN/SI(PPRESSIpONiSYStEM „ At t Sewage Ejector or S p P mp Other:
<br /> Water Suppr-; ion 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 comp •th the State Contractors Law 1 27 RCW and 296.200A WAC.
<br /> City of EveI g 091)rett Official Use Only
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<br /> 7 3/ / � PERMIT#
<br /> Owner/Au orized •.ent Sig at ire Date (Revised 10/10/2018)
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<br /> C.—
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