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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 FAX 425-257-8857 (E)everetteps@everettwa.govI www.everettwa.gov/permits <br /> (Bill('or Black Ink Only Please) PROJECT SITE INFORMATION <br /> ocnvA- tvsn crr F,tc'L,ry $t,D6r Lio N-t <br /> PROJECT SITE ADDRESS:30 o3 G11esr rAshod Ro,n svcrcsrn 6 JA it zo3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: j p L/N(� Cent p.i y TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET PO (3,o x o At< (o A t O <br /> CITY C.1 r rL STATE WA ZIP Q B.t <br /> OWNER PHONE: 122,iy KImo2• M (Las) 3O-18o7 OWNER EMAIL: RA/itt co.A.tnlMcRtr.Jg) 6oruvbr, coml. <br /> CONTRACTOR NAME: CT IZES/V R L 2 fzy =nir)usr t2 t.a,L. L-LC.. <br /> CONTRACTOR ADDRESS: STREET 1180 N G..J M h PL L Sr- sr L. 2.00 <br /> CITY I S S AtktiAl-t STATE (it/A ZIP L(S o 2 f <br /> CONTRACTOR PHONE: (425) cud - u7op CONTRACTOR EMAIL: 113,x0lv,soci+69_ atZ££NRCR2Y.LC HA <br /> CONTRACTOR LICENSE#(REQUIRED): 64.RL L N X L q 2(o M g- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S 7'(p 31 <br /> PRIMARY CONTACT: 0 OWNER al CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �AS0N Svc.--F CONTACT PHONE: 362p_eiZto -Got (f1- <br /> CONTACT EMAIL: ,)moo N,S u c-tt-c G,-met N ti 2 riy.c d apt <br /> BUILDING INFORMATION <br /> Existing Use of Building: FACTO my Contract Price of Work:$ 1.__.9°I <br /> Proposed Use of Building: A(o Cy ,N&cF Heat Source: ❑Gas ❑Electric DOther <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family #Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel NRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: (Z pt,A-c cot twrT' of GooLlrv(,r- TowtrL sYSre:vi.. W et".K <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 List of Fixtures <br /> A/C—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 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 1, Other:CooLleur Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log To4'c-2. Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System I 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 authorized under any circumstance.lam 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 /> PERM T# <br /> caner/Autho I en Ignature ate (Revised 10/10/2018) <br />