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-- PERMIT APPLICATION I'I
<br /> BUILDING) IIINECHANICAL/ PLUMBING /SIGN ) SPRINKLER I DEMOLITION
<br /> EVERETT CITY 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 I www.everettwa.gov/permits
<br /> (Blue or Black Ink Qnii Pleased . . ..,t..,PROJECTrSITE NRORMAT'IOI!).. bB.,,.. t, a.,. .,.,.,. . . .,.:,_ . E.,..,
<br /> PROJECT SITE ADDRESS: )150(Ai. Met.t;he Vteu) P,r, £,;- 6 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ,. a,, ., . m.._ ,. , '. .. ° CONTACT I.NFORMATJO 1 g : ,_, .
<br /> OWNER NAME: Flirt of 6-(e e.-77 TENANT BUSINESS NAME(Commercial): arra fF tir7
<br /> OWNER MAILING ADDRESS: STREET I POS C ,,t,A,r, Wk„P 41.2co
<br /> CITY C.fe..tr7 STATE' ZIP
<br /> OWNER PHONE: ql5 330 75 g OWNER EMAIL: (7
<br /> We_ -4# Por? 6�Eytve l CU r'1
<br /> CONTRACTOR NAME: f ievr‘s 4 94
<br /> CONTRACTORADDRESS: STREET � k\3�f3b jZir-p,�-f D( .
<br /> 360 739 ,�i/ QN
<br /> CITY I : �A.vY\ STATE W A ZIP B 2 2 j,
<br /> CONTRACTOR PHONE: @@ CONTRACTOR EMAIL: jaANtk u v Ce p8100•adrn
<br /> '�
<br /> CONTRACTOR LICENSE#(REQUIRED): g, UI3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER 11••: •NTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: * CONTACT PHONE: 7,R.:‘,..„..,,,„@,3(pO 2,0)(98 j2�(, '
<br /> ��'�~ �I\OW.,(V CONTACT EMAIL: !✓L3'v,�.�""'
<br /> B ONC IDR A`TION `, _. z tw .. _i v
<br /> Existing Use of Building: (3f c,e4)4.tt. Contract Price of Work:$ 30/800.00
<br /> Proposed Use of Building: s Heat Source: ❑Gas ❑Electric Other 1-froa F -.p
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: C� ,,' Kt I Re-004.4,4...P7 oe I A-fori O F,50c 5P4-6y5r„ t4e04 f '"-Ps
<br /> 1/4
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATIO,01: ,:,..., ., '!011i1RN41G PERAMtitio0 IC!ATIOt :...n. :,
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> a, 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 /> Clothes Dryer p`1 Heat Pumps 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 /> ,,, ,SPI'RIN +CLER/S JPPRESSIGN 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 ork 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 authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the 'tate Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> \ n2pt&,_______- / /f2iii / bPERMIT# �
<br /> Owner/Aut, rized Agent Signature Date v (Revised 4/15/2019)
<br /> 641/
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