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PERMIT APPLICATION
<br /> BUILDING I MECHANICAL 1 PLUMBING I SIGN I SPRINKLER I DEMOLITION
<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 govipermits
<br /> :01, tflko ) . , ,. I..' .OROJOCT.SIITE.IHFORMAT`IO I.
<br /> PROJECT SITE ADDRESS:Ala 7 /a9 , Si 5' 1,--4110, PROPERTY TAX#:28041 gdoe1,00eiv
<br /> LEGAL for new construction: Short Piatisubdivision Lot No. (attach copy of long legal description)
<br /> CONTACT
<br /> INFORMAlI N
<br /> OWNER NAME:eft, i, e '1S9 d ae,TTENANT BUSINESS.
<br /> NAME '
<br /> OWNER MAILING ADDRESS: sTREET f97 /D -.C%45261 t
<br /> /cnv �rj�%7.'ti�M STATE
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<br /> ZIP
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<br /> OWNER PHONE: 6 - /'O? '7275 :OWNER EMAIL: 5 / �in 61 1 CIPIU p
<br /> CONTRACTOR NAME: LNp ,, ',Kw' dec.,/ M
<br /> CONTRACTOR ADDRESS: sis eT J t 10 7 �M /Y If (!
<br /> /� CriY /t7r�f op STATE /� /ZIP ID 375
<br /> CONTRACTOR PHONE:A53'.3 07 " 3 7i3e CONTRACTOR EMAIL: L olr 1V AOr!_, dew)
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<br /> CONTRACTOR LICENSE#(REQUIRED):.,!V r)cEI -1?,3 big CITY OF EVERETT BUSINESS UCENSE.#(REQUIRED) (01)2.1 UG1
<br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR `OTHER(Please Specify)etiE C%' �� . a ' l
<br /> CONTACT NAME: ,•� `CONTACT PHONE: 3 - >7`1j// }� f ,,
<br /> 064/fAmi Q CONTACT EMAIL: ,)t!7�- ie A/ W19 5'/-' (OM SN [_ Gd
<br /> .BUILDING INFORMATION.. . ;;::: ''''.".-:'Y::1:','','... ;.,,,‘' .: . ',., '.2.'fij..::'''' ..'',''' .:,: f
<br /> Existing Use of Building: Contract Price of Work:$
<br /> Proposed Use of wilding: Heat Source: D 'Gas iectric DOther
<br /> BUILDING USE: sFR DTownhouse DDuplex DADU DMulti-Family-#Units: DCommercial DAccessory Structure
<br /> Type of Project DAddition DRemodel ❑Repair DTIDSign DSprinkier ❑Demolition DChange of Use
<br /> DESCRIPTIO OF WORK: % f , S f
<br /> INsrs /1 New r 1pA O 4i ' - I' A > p Fx
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<br /> S Ie ;A/ XI "M//4--":" i'rne /7R, ^ �w
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): G U3 SU`� I MI
<br /> MECHANICALI PERMITAPPiiICA ION PLUMBING PERiI IT APPLICATION , .. .
<br /> "m List of Fixtures Flour' List of Fixtures R' rre List of Fixtures Fixture List of Fixtures
<br /> Count Count count Count
<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,tloor)
<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 Ventilator Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Water Heater interceptor-Grease WasteiWater Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil ( Water Service(behind meter)
<br /> Forced Air Systems Other: Medical Gas 1 Water Valves or Fixtures
<br /> Gas Freplace/insertiLog Roof Drains Water Heater
<br /> SPRINKLER I PPRESSION$r' STEMI1 Sewage Ejector or Sump Pump [ Other SA
<br /> Water Suppression System I 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 auth. %=•und' any circumstance.tam the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,
<br /> and l comply with the Stater .rs -=w 18.27 RCW and 296.200A WAC.
<br /> C of Everett Official Use Only
<br /> /// r tZ•4)<<JA,; PERMIT# _ /S 1
<br /> V11-111
<br /> Z�//9� � ifl�
<br /> OwnerlAutho ed Agen . -tore Date/ (Revised 10/10/2018)
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