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PERMIT APPLICATIO111
<br /> BUILDINGECHANICAL/ PLUMBING /SIGN 1 WINKLER/ DEMOLITION
<br /> #.111P/44 .-'-"-A
<br /> - CITY OF EVERETT PERMIT SERVICES
<br /> � �� . 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> ;PROJECT SITE ADDRESS: l(pO� CH c NV"V V. ep..,c ,«)A PROPERTY TAX#: OO (013—Oak O\5-(3b
<br /> [LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description)
<br /> 777777 ,,,,-.41,,,-.„ '� .. �c�§s Y 'dA 'fit 33"m ;v;.y
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<br /> OWNER NAME: Pi\Pt'6\S E v,. .....5.--c- , lA..C. TENANT BUSINESS NAME(Commercial):
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<br /> =OWNER MAILING ADDRESS: STREET 232-bs 0:1 �` �l SE
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<br /> CITY �eAr q 8-to STATE W ZIP t ,S
<br /> gOWNER PHONE: (2.,S 3'ctO5- \Liclic OWNER EMAIL: C nn t ZS(v @• MCMI CQYy>,,
<br /> [CONTRACTOR NAME:TSD o 6 m1-e f (anC,Tr(A,01 r— I Yi c
<br /> =CONTRACTOR ADDRESS: STREET L'l Li ' ice 1 ) F P 1, ,.b
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<br /> ' CITY `� V V V Mil..... STATE A ZIP q 8 i i V
<br /> !CONTRACTOR PHONE: 7� � CONTRACTOR EMAIL: ."/ leo 2 0' o
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<br /> LCONTRACTOR LICENSE#(REQUIRED):\)b (Y Y l` °t I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):TJ° 5
<br /> (PRIMARY CONTACT: lhoWNER 0 CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: C LA �� CONTACT PHONE(2S )q S I yR
<br /> I CONTACT EMAIL: c m t Zc�(o Oez,o...41.C GVY,
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<br /> 'Existing Use of Building: ' Contract Price of Work:$_2.5 , CTfTO
<br /> !Proposed Use of Building:5 R Heat Source: igInas ❑Electric ❑Other
<br /> I?3UILDING USE: SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
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<br /> I f •e of Pro.ect: New ❑Addition NRemodel ❑Re•air ❑T.I. ❑Si•n ❑S•rinkler Demolition ❑Chan•e of Use
<br /> DESCRIPTION OF WORK: vi ,c� Q W 0.
<br /> �- > �� 'C�N�rvc�� 6'2\occ1/4,�� �� \0."`�`�``i ,�.r,c�c\/1+Y\.es,
<br /> (P Cmc c\ fO tt 42-,Ove.rci `J 101'1'.\ c o, 053
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> !Vlp �HAW� �k »PERIVfIT M. t 1 . „a Fp„:„::;;;-;„.0'.:„..7".7.11,,,,,T',..'':::::' �° A� '``ma x":.
<br /> Fixture Fixture Fixture Fixture
<br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures
<br /> ) Count Count Count Count
<br /> A/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) 2 Shower,Tub,or Combo
<br /> Boiler Gas Range 1 Clothes Washer Sink-Commercial(3-comp,prep,floor) •
<br /> ( Clothes Dryer Heat Pump&Ductless ) Dishwasher
<br /> _.._1_e. 3 . .1 Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
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<br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain �j Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal ,
<br /> ,4
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<br /> ExHood(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 S Water Heater
<br /> SPRINKLER:1,SUP..(p,RESSI :.
<br /> �,,,, ,, �, y Sewage Ejector or Sump Pump Other:
<br /> tar Suppression System No.of Heads --—-"J
<br /> :hemical Suppression System No.of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein istrue 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.
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<br /> ACity of Everett Official Use Only
<br /> Vv` -7 I PERMIT#6 \102_ cm
<br /> Owner/Authorized Agent Signature 'ate (Revised 10/10/2018) 1
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