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12101 <br /> ILE PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING I 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 I(E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7.„771.52 ertklna ve- ,PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> j r I dux <br /> INFORMATION <br /> OWNER NAME: t� Qih <br /> . ,1 '\�i,nu.f.A Wx 1{(0 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET �� Z be-mad Alf. <br /> /-C VJex.(Ai- STATEVAk- ZIP ZCl <br /> g <br /> OWNER PHONE: Li 2' —Z✓ '")" 12_517 X 2,05 OWNER EMAIL: <br /> CONTRACTOR NAME: EU ( >5 nr'(!,Une //f L <br /> CONTRACTOR ADDRESS: smEEr Z.(Z..0P/-1-Ct�L C.- <br /> CIN C t/l^fI.L7-1 C"- STATE Li...M-L alp 4 1 <br /> CONTRACTOR PHONE: Ha-) 2S Z-.3/f`1- CONTRACTOR EMAIL:al/VI SSt @ e SS m(A.)ct r// oIen <br /> CONTRACTOR LICENSE#(REQUIRED): .6-.1) 55C'2-ZOT— CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):OO19 55' <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ®OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (Li-ZS1 50g.-07Z-7- <br /> fa . Lf oviss(, (.5)ton els CONTACT EMAIL: ejletY IS G „stlYiw-• '';...tYy, <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 69 SO <br /> Proposed Use of Building: Heat Source: OGas IEtIectric L0Other <br /> BUILDING USE: DSFR OTawnhouse ElDuplex OADU OMulti-Family-#Units: 'A Commercial DAccessory Structure <br /> Type of Project: ONew DAddition ❑Remodel ❑Repair KT.!. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OP WORK: <br /> c\ZsI,Ocia -e\ Is-k-vv19 DJ - *Liz/a-0 ,k, W I SGvwtt, kod1/434,w6 1 4 . <br /> cet4tuic lin S oh.t sto citn P1 at,S 64 <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 <br /> _ <br /> List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventerjinside Bldg) Shower,Tub,or Combo <br /> Boller Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer t 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 Ventilatior 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 f 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.lam the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> NAA,C6V1 Yew ill f ) PERMIT S o,; 0/� <br /> Ow r/Authorized Agent Signature Date (Revised 10/10/2018) <br />