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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> 10 <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 <br /> (Blue or.Black Ink Only Please) PROJECT SITE INFORMATION <br /> to <br /> PROJECT SITE ADDRESS: 1 tL© ?- Oc.V c6 Ave_ aartit w A q52.0 l PROPERTY TAX#: OQ (422. cioo4t3f) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: a(r .1..va5vA TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1040'4 COLAs kw_ <br /> CITY E\)Lr s L k.' STATE W ZIP $Z� „-- <br /> OWNER PHONE: 415- KZ 5 3C(ck OWNER EMAIL: Eli.Dcoascm S`�-@ C`�nna.k.Luw. <br /> CONTRACTOR NAME: 1j�36.fy Q'e,� <br /> CONTRACTOR ADDRESS: STREET leo 4 1\,)E" \4 c4 <br /> CITY ��GS Lt,�,v,_ STATE W(St-- <br /> CONTRACTOR <br /> - ZIP $TOR PHONE: 47.5 - 40c 2.4-4-1 CONTRACTOR EMAIL: }j c��vv�.en g �2v�reQe Se,,A- �,Cows <br /> #(REQU <br /> r(Rc6 E'dd dgt ED) CONTRACTOR B❑OTHER R(Please Specify)i' 1[,O2 BUSINESS 4't 6 LICENSEI l I <br /> t1) <br /> CONTACT NAME: �� CONTACT PHONE: /� l{ZS�t{+O _Zt� q <br /> C.v� ciBv‘ l�tri+ ILA 1Y`t e,(564 CONTACT EMAIL: tfy�+',1,,,la (�,3G[r'Q �- :4 -\e.l' un <br /> BUILDING INFORMATION <br /> co:- <br /> Existing Use of Building: f0 5\dty1C-Q. Contract Price of W: :$ �';.� � 111. <br /> Proposed Use of Building: ' S%dc,A.cc Heat Source: ❑Gas • ectric '740th:,r i i <br /> BUILDING USE: .ISFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: DCommercial ❑Ac ory Structur- <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> kiL..1 ©.A-Liotti o 2/LA cbt,t \,l S• X 1 2—1 <br /> 51� L.4 V Ie, Zv d Si-or y <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) I Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher 1 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> I Exhaust Fans(Residential) Commercial Ventilation 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 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.I am the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with a e ontractors Law 18.27 RCW and 296.200A WAC. <br /> -. City of Everett Official Use Only <br /> • PERMIT#ex \ op/ <br /> to <br /> •,a,11�"-�'�. e. .gent Signa r- Date (Revised 10/10/2018) <br /> 1 <br />