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46-n- 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) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7€jy /12 h Sf St {,/ LV4 PROPERTY TAX#: 7525-/%,o ge72k00 <br /> LEGAL for new construction: Short Plat/subdivision .-- _.. _Lot No.----- (attach copy of long legal description) <br /> /l / S2�^� CONTACT INFORMATION <br /> F <br /> OWNER NAME: I� C�l71Ish (nn 2. TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET /// !N!9� /*a/ CG1 7q Ste/o ' �] 79037 n <br /> CITY 17nrnwor STATE /VA zte/ 903 7 <br /> OWNER PHONE: (I.-2.S- .777 -2-04 G OWNER EMAIL: C/2P't'$ 0 fil h SG sJv'e/ / <br /> CONTRACTOR NAME: SA-A1.4 /4,S OK/A/.. e. / <br /> CONTRACTOR ADDRESS: STREET —- _ <br /> CITY STATE ------• <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: – --� <br /> CONTRACTOR LICENSE#(REQUIRED):jyrcr✓p/ fT 47257511"-- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 597 3 2-- <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:: CONTACT PHONE: (./.2.T.') 922— 2eva <br /> 1 /fS A-nde/son CONTACT EMAIL: rhv'osCom' h.0)se .p,�, <br /> / <br /> BUILDING INFORMATION <br /> _ <br /> 1 <br /> Existing Use of Building: f/acoof7' /4t7yyie Contract Price of Work:$ §e/9";D�,7 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: 4BCFR LlTownhouse •Pfhaplex g.ADU OMA-Family-#4419its; C3Eommercial B tecessory Structure <br /> Type of Project: New Addition 'Remodel Repair 'lT.I. RSign ❑Spiiirkler iDemolition -Change of Use <br /> DESCRIPTION OF WORK: <br /> ,Vere 2 5Ie home amei 01J7161,; li <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Cou�t List of Fixtures Cfunt List of Fixtures Co fit List of Fixtures Cort List of Fixtures _ <br /> NC–Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> - <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain !! Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain 1 Toilet <br /> Exhaust Hood(Type I) <br /> Exhaust Hood(Type II) <br /> (Not Heat/AC system) Hose Bibb _Urinal <br /> 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:1 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 l comply with .e State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of EverettOfficialUse Only <br /> /4)4,4_ / PERMIT# \� Dlbd2 <br /> O er/•uthonnt Signature Date (Revised 10/10/2018) <br />