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isming I <br /> In PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN I 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 <br /> Blue or Black Ink Onl Please PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 43-a.... RLV ider_e_ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: THE 154c)e 614.,,t. TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET YIZ1.... R-ce.....k Q-12. A <br /> cny E-veao-n- STATE WA,% z Ife_0‘ <br /> OWNER PHONE: Ciiis 330 -- 2-051 'OWNER EMAIL: lu if <br /> CONTRACTOR NAME: E ...,.cs, -,.....--, . - . --.... i.,. -- <br /> CONTRACTOR ADDRESS: smeEr 2,,A 2..0 <br /> CITY EV(:::IZZ:tr^ , STATE t,„41,A4. ZIP q g7-0 j <br /> CONTRACTOR PHONE:NW gSI- 3 /1' CONTRACTOR EMAIL: kie kLal...e5frk1tc/Ct..aok-c, <br /> CONTRACTOR LICENSE#(RECtUIRED):eV _, ao „... CITY OF EVERETT BUSINESS LICENSE ft(REQUIRED):00 1. <br /> PRIMARY CONTACT: 0 OWNER fa-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:k Ltzs-) 5Zei— <br /> ) e),) h Lb CONTACT EMAIL: j•‘e tLi,0,,e5sy24 . Coot. <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ '7 • <br /> Proposed <br /> - <br /> Proposed Use of Building: Heat Source: OGas jElectric °Other <br /> BUILDING USE: OSFR OTownhouse ODuplex DADU CIMulti-Family-#Units: Wommercial DAccessory Structure <br /> , . <br /> Type of Project: ONew DAddition ORemodel ElRepalr OT.I. OSign OSprinkler CiDemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> 00 t L—4 4.0ve-1.05.1*.v> ((A (r: 0'117)6)02.- flN <br /> Lo ' ,,,r cl.- -i-c- 6t0,-ii.-)b ct.:.-) 49e.-t- 0-E Stc\. <br /> ASSOCIATED BUILDING PERMIT#(If applicable): , <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Maw° List of Fixtures Fixture <br /> List of Fixtures Fbdure List of Fixtures <br /> Count Count Count Count <br /> A/C-Air Handling Units GasPlping Backflow Preventer(Inside Bldg) _ <br /> Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer - Heat Fump&Ductiess 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 systemL 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 I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other. _ <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 1, No.of Heads ...... <br /> ACKNOWLEDGEMENT;I have reviewed this application and confirm She information contained herein is frue 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 1 comply with the State Contractors Law 1 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> )2.1„,,,.._ 47.„."6 <br /> LERMIT# At A <br /> 111 vl\f/;- ii° <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />