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• <br /> • <br /> '' PERMIT APPLICATION <br /> A,10/. ,111111BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425 287-8810 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: j532, 13RoADW�-`( T --JPROPERTYTAX#: <br /> LEGAL for new construction: Short Plat/subdivision If Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �1)t4t L14?S G(;) TENANT BUSINESS NAME(Commercial): ` 6 G <br /> OWNER MAILING ADDRESS: eraser 35 31_ 13 p)As , iv/4, t- <br /> CRY 1 /1)-6.. ` I STATE VY///� <br /> R' _, p7dA ..,_ .a OWNER PHONE: ,I '''5 ' 7 j`._20 t`L. jOWNER EMAIL:4-1, 4- S A-D S t 6,N e <br /> CONTRACTOR NAME: t'"t'eA-114 Nro f-T1 W ES { <br /> CONTRACTOR ADDRESS: STREET 5 k.:.r-7 2-1`j.`^�t 5, 1, ` 3 T �p <br /> any 4 LE. STATE VY % z,p V 41 '1 <br /> CONTRACTOR PHONE:21)G G23—3100 1CONTRACTOR EMAIL: Li SAC GA5CJ pf- <br /> Si G ' .t:.ciM <br /> CONTRACTOR LICENSE H EATt4 141 ci Y „ T iCITY OF EVERETT BUSINESS LICENSE#(REQUI- D):024- 1611 <br /> PRIMARY CONTACT: ID OWNER CONTRACTOR CI OTHER(Please Specify) arm i i 14 Lj tell <br /> I l <br /> `^�' � <br /> CONTACT NAME: CONTACT PHONE( E O3) 37r -._OC <br /> 1 2- <br /> L1S1\ ki mKr E .. CONTACT EMAIL:LlpAt CA-5 '1 G3� + <br /> BUILDING INFORMATION %� � <br /> Existing Use of Building: C5 tfo N Contract Price of Work'$ b <br /> Proposed Use of Building: ("AS SIMI0 h) Heat Source: °Gas f DElectric ther <br /> BUILDING USE: DSFR DTownhouse DDuplex DADU Multi-Family-#Units:, l <br /> Co dal DAccessary Structure <br /> Type of Project: ONew DAddition DRemodel DRepair DT.i. Slav DSprinkier DDemoiition DChange of Use DESCRIPTION OF WORK: <br /> sv, 2 r4c1 STfrJG 0414opt(' ,GIcr i CSi.liti.6._ 5rz.. ) <br /> I2, .—F ` .t5T I NIG Po La- St G tJ A"RI 51 2--) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures ` <br /> Count ,`: List of F urea Fixture List of Fixtures Fixture List of F/xtur�es <br /> Count Count <br /> NC-Alt Handling Units Gas P no Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler G Range Clothes Washer Sin mmerdal 3-com <br /> Clothes Dryer eat Pump&Ductless Dishwasher ( ,bath,,ilr) <br /> Dust System(Remodel) Refrigeration _ nk•Residentlai(kitchen,bath,bar) <br /> ge -Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventiiatior Floor Drain _ Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Dpe II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Reeiden Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Firepiace/Inse og Roof Drains <br /> Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System INo.of Heads <br /> Chemical Suppression System I 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 perm t only authorizes approved work and no deviations therefrom.Deviations must that be authorized In writing from the <br /> Building Official before being authorized under any circumstance./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 Contractors Law f8.27 ROW end 298.200A WAC. <br /> City of Everett Official Use Only <br /> 2 c—tA. Fo —cc9 <br /> Owner/Aut orized Agent Signature Date (Revised 10/10/2018) <br />