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ii <br /> • PERMIT APPLICATIO• <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 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: /AS fi I DAS 2,LL25 L.UA Ick. NotiERTY TAX#: <br /> Plat/subdivision Lot No- (attach copyof longlegal description) <br /> LEGAL for new construction: Short Plat/sub I 9 P <br /> CONTACT INFORMATION <br /> OWNER NAME: MC OK/ 134( TENANT BUSINESS NAME(Commercial): L/%.D FP PASS <br /> OWNER MAILING ADDRESS: STREET . (L)25 L C1 @ Aviy C c) <br /> ccm, E•.tE-('--E i 1T STATE Gi. ZIP 9�LC l <br /> OWNER PHONE: ",53 - ?O(t,, 55 0 OWNER EMAIL: <br /> CONTRACTOR NAME. 1=i ‘")!-`}IYAC•,iNG, J 1-LC <br /> CONTRACTOR ADDRESS: STREET)) �/1 V-A l.'O 52-N AV[ G.) . U I` l I )S � z <br /> CITY ^ViON L O 0S) STATE (42 A G <br /> ZIP ( g 0✓-4 <br /> CONTRACTOR PHONE: '/Z 5 / 7�/ 5VOZ CONTRACTOR EMAIL: CLI 8v4'-X-3 43 c' i I•CJm l <br /> CONTRACTOR LICENSE#(REQUIRED): :SI)?1 J P 1-1 )- Q Li-) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):?pc,0 <br /> PRIMARY CONTACT: 0 OWNER to CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: it/) 9 7-/ 6'0 2, <br /> g 06 e +�i is L CONTACT EMAIL: dtt,civ a c .A C'Mc>,i 1 . Ca1(v-1 <br /> BUILDING INFORMATION <br /> Existing Use of Building:VVAcsA.'T Contract Price of Work:$ 'f/j Cl 00 - (-)0 <br /> Proposed Use of Building: f C C.) Si.tPCE `›,AGtc Siilh f,)r Heat Source: ISIGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU 0 Multi-Family-#Units: ACommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition 0 Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition JaChange of Use <br /> DESCRIPTION OF WORK: / t J1LL RE /N5VALL,,-J(o P!-u✓l.6140c Fr1e7L(ES To -F-v,aN twe VNIT (N•it, A <br /> Ki re► iJ <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 41/X 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 43 Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater I. 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 jC' €LOCL Si M K <br /> Chemical Suppression System No.of Heads `I J1,lui T y1 g 4 ifrjoY{4$- <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.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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> --------) /jj <br /> 01-2 lift c, - 02_14 - _, <br /> Owner/ uthorize Agent-Signature Date (Revised 4/15/2019) <br />