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• PERMIT APPLICATION <br /> mg <br /> BUILDING /MECHANICAL I PLUMBING i SIGN i SPRINKLER/ DEMOLITION <br /> EVERE T T CiTY OF EVERETT PERMIT SERVICES <br /> c 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*SIack.Ink Only Pleas®) PROJECT SITE MNFQR(4AA_T10N1•,•:: <br /> ,ROJECT SITE ADDRESS: \12 .-- CAHAH (I 0,\/ i -- - PROPERTY TAX#: 0O'c13'j o D 5-0'PI-4®j <br /> T <br /> .EGAL for new construction: Short Plat/subdivision 11eAlQX l"r�GL.t.. •. Lot No. I (attach copy of long legal description) <br /> .,CONTACT-1NFOAMATiON: . . <br /> )WNER NAME: `�(\ MA (� rPl . TENANT BUSINESS NAME(Commercial): <br /> )WNER MAILING ADDRESS: STREET 1 I3.)t) LI 1 ' AlVt. <br /> �C <br /> 0-t2 cm, 4/lt"}►(`4A ( STATE VI U\• ZIP L )0 t . <br /> )WNER PHONE: O 1 ---S 1 / OWNER EMAIL: I v U-`' , e cx`'FSSU • c.�Cl <br /> 3ONTRACTOR NAME: -D lA `� <br /> ;ONTRACTOR ADDRESS: STREET /147 1 I P'L.Llk_ 0_/iV— (% )/� <br /> CITY YU-a r) STATE � LP 6O / J <br /> ;ONTRACTOR PHONE: (Q r) • LOt-{'- L 575 CONTRACTOR EMAIL: (1'{Lo}%)Q,,,/to- 2 Q i d • _ , <br /> )ONTRACTOR LICENSE#(REQUIRED):T', e-�`r L 0- CITY OF EVERE T BUSINESS LICENSE#(REQUIRED) Dt OZ <br /> 'RIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> :ONTACT NAME: CONTACT PHONE: ''j R0 . I.10l..//��. 22- 5--(ItOV l Y1a :jit.�-rn CONTACT EMAIL:1)DviAn it ()A ii,e, t'4 1 lik,ivt,a ,r. • <br /> . ... DI Q..INFCIRtV#AT10i+II.1 .. .. . . <br /> Existing Use of Building: 6 is g'brI,(2 Contract Price of Wark:$ 2-+�i l • CO <br /> roposed Use of Building: 1 Heat Source: DGas ❑Electric ❑Other <br /> WILDING USE: ❑SFR DTownhouse DDuplex DADU DMulti-Family-#Units: ❑Commercial 2 •ccessory Structure <br /> -ype of Project: tkiew 0Addition DRemodel ❑Repair ❑T.I. DSlgn C)Sprinkler ❑Demolition ❑Change of Use <br /> )ESCRIPTION bF WORK: <br /> RI f x 3 0 I dos-- o 4.1,a4 - - 540 C ft. <br /> kSSOCIATED BUILDING PERMIT#Qf applicable): <br /> MECHANICAL•PERMIT APPLICATION:'; : ;`. :,:` .`PLUMBINO•:PERMIT APPLICATION::'' <br /> Fixture Hem Fixture Fixture <br /> Count List of Fixtures count ' List of Fixtures Count List of Fixtures Count List of Fixtures <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,fioor) <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 Vanttlatlor 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/011 Water Service(behind meter) <br /> Forced Alr Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I.;SUPPRESSION SYSTEM-.-'.. Sewage Ejector or Sump Pump Other: <br /> crater Suppression System No,of-Heads <br /> Ihemicai Suppression System No.of Heads. <br /> ICKNOWLE GEMENT::I have reviewed this application end confirm the information contained herein is true and correct,Work done pursuant to this permit must comply with <br /> wentfe rel,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized/n writing from the <br /> Wilding [tidal before being authorized under any circumstance.lam the owner,or t am authorized by the owner of this properly to perform the work for which application is made, <br /> net c9 ply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official UseOnly <br /> � � PERMtT#t-,�� z (✓ <br /> L <br /> I nor/Authorized A ant Signature Date (Revised 4115/2019) <br /> I yy <br /> ;7 <br />