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OLT PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please)ddPROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: iota ' 31`() AVE PROPERTY TAX#: Q 0 Sop y UCS 1 00 Sx.t <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CLM PIOrestsGclqtrZrYtsi`.LC.. TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 4 i-c( AJ KeA,,,e,., St, S)`e_, 165- Vo <br /> CITY Mot(be__ STATE \_A- ZIP 9 D�7 <br /> OWNER PHONE: 40 E 39U --.7;; 6 7-t 1_ OWNER EMAIL: G�(OA'b� l? ?i'K-ott I . (...,- <br /> CONTRACTOR NAME: C I e I.}G it- (04.`>T"I u-i-'+;OY\r I 6— <br /> CONTRACTOR ADDRESS: STREET 7-166 1 ,(J 0161. (s(y 1e_ f}iq <br /> CITY S/4„y 0 y1'1 4ji'l STATE 4 ZIP '0Q 85 <br /> CONTRACTOR PHONE: L{®6--5616---) C 76 CONTRACTOR EMAIL: GX WL$s10G 3,,,,,,,i,l.cart <br /> CONTRACTOR LICENSE#(REQUIRED): CL/TEA 4tiq CD CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5-5-5—Z3 <br /> PRIMARY CONTACT: igl OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> /� ,�` r 7 u0 <br /> Existing Use of Building: (te4 enll&" " J:Ngle (tit""Li Contract Price of Work:$ L\V), <br /> Proposed Use of Building: RzsiaiMt,-ai —S t% l$ fet.r^Iii Heat Source: ❑Gas NElectric DOther <br /> BUILDING USE: FISFR DTownhouse El Duplex DADU El Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel gRepair ❑T.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: (j.wr <br /> „fiSMI _ .. , l I IV{ .-4„„..„ tPi) . W i l <br /> MECHANICAL PERMIT APPL .TION PLUMBING PERMIT APPLICATION <br /> Fixture ��\ List of Fixtures Fixture List of Fixtures Fixture List of Fixtures Fixture List of Fixtures <br /> Count co Count Count <br /> A/C-AiNiandling Units Gas Piping Backflow Preventer(Inside Bldg) . Shower,Tub,or Combo <br /> Boiler ` Gas Range ._ Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> 1 Clothes Dryer N- a. Heat Pump&Ductless ,1 Dishwasher S Sink-Residential(kitchen,bath,bar) <br /> Duct System(Rem..e Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> -3 Exhaust Fans(-•sidential) . Commercial Ventilation Floor Drain 3 Toilet <br /> Exhaust Hoo. Type I) .N (Not Heat/AC system) _ Hose Bibb Urinal <br /> Exhaust.sod(Type II) j ' Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exh-• t Hood(Residential) d Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> orced Air Systems Other. Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains 1 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,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. <br /> ') City of Everett Official Use Only <br /> '!—� �� �� PERMIT 0 1, IA) <br /> 0 to�� <br /> u <br /> --- ,C Oyv er/Au horized •gent Signature 'Pate (Revised 10/10/2018) <br />