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....; PERMIT APPLICATION
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<br /> ® BUILDINOOIIECHANICAL I PLUM r INO I SIGN I !':INKLER I DEMOLITION
<br /> EVERETT E� 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 Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 1—S CP 4- (,('ct 4 A V E STe WPROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: LT �4eiz_LSE y LL( TENANT BUSINESS NAME(Commercial): `- )-pc;kly h 1:,,ft>S.
<br /> OWNER MAILING ADDRESS: STREETJ, 2g04 (.,j�„t01 Av E S I t, /()0 j�
<br /> � CIITi' T,0.4 1 STATE� �Li 4 ZIP q X 201
<br /> OWNER PHONE: 4_9(0 • "( 4-01 (c o C�OWNER EMAIL: Kan,l)...,C' CCt. L. VLv'7I`
<br /> CONTRACTOR NAME: '\-)(,�t''k /S I(,(jvn, iD lky , (,/✓
<br /> CONTRACTOR ADDRESS: STREETT 1 �3g 31 r J.3s - � N 1 .l
<br /> CITY i---- tO✓L. STATE i.)A ZIP 9132,2.3
<br /> CONTRACTOR PHONE: 426 2J e B 4 q 43 CONTRACTOR EMAIL: CV'J< /tab) ( J''- 1 ,(o 4"-
<br /> pi._ "i l+ -1 rri ir,
<br /> CONTRACTOR LICENSE#(REQUIRED): pig Z K.` ; c•,% N ,:,)& CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 1NLOWNER ❑ CONTRACTOR ❑ OTHER(Please Specify)
<br /> CONTACT NAME: - ��q� CONTACT PHONE: 2O(9, DI�G1 ,, 4-G( �^L0
<br /> I\ CONTACT EMAIL: ,I 1 }�p��,�C3 ACa<4-r ii f11
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: r _ ,,, .s;,,,,i ;-, •. Contract Price of Work: $ 4-4-0
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. OSign OSprinkler ❑Demolition OChange of Use
<br /> DESCRIPTION OF WORK: k V15..w civ,y,".b4 1"'o r c R tOvt&VIA.446,-qi\ )c(-i-G `
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): iAO O-Dk 1 A' P ! wiz o i>%lk-U e, ' lyd \0I4 4i.c AD.
<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 5 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 Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains I 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: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 ized 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 I comply with the State Co actors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> / I7 /1$ /4 PERMIT('I�1�, D
<br /> Cam — /
<br /> Owner/Authorized Agent Signature t ate (Revised 4/15/2019)
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