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= 0 PERMIT APPLICATION <br /> az <br /> 3UILDING / 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: j 26z07 t _A c iiL/f,�j. At E PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: r)r, Tade 6G--7 TENANT BUSINESS NAME(Commercial): 'Dr.. Jo,'(e___ Cc..� <br /> OWNER MAILING ADDRESS: STREET /Z 90Z goiJ .J- 17, r-r, /} / $ ))tE <br /> CITY ems/^2"f- STATE Lt,L!T- / ZIP 9SZG,5 <br /> OWNER PHONE: 7 - SSC:Z`- 7��3 OWNER EMAIL: J oc(t��'47,2 dds �5irkl; - Lt'�5 <br /> CONTRACTOR NAME: gI'r. ,S'4,. <br /> / N t 72, C/ <br /> CONTRACTOR ADDRESS: STREET /95 , 0 3 8- t-` _ fU r_ <br /> CITY La k f FC) f"- Yc- IL. STATE (1).4- ZIP y':s--/.5J� <br /> CONTRACTOR PHONE: ZUX'.Z3-Y-0936; CONTRACTOR EMAIL: C,t'',ly �.5- cL r7Or: ,ves A«%--, <br /> CONTRACTOR LICENSE#(REQUIRED): s N s---//cc CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): tj 1 `4 <br /> .. <br /> PRIMARY CONTACT: 0 OWNER IaCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ZC ,_Z.5-y-c.jy6-: <br /> _J :a.S 7"> L>Ili CONTACT EMAIL: d/o--j(,?; ),gsk7/7Gv-1-4 fir}Ccc--5 <br /> BUILDING INFORMATION <br /> Existing Use of Building: K-.P.}r.;./ Contract Price of Work:$ 2....._7U/ r`-'L-) <br /> Proposed Use of Building: '��,.-y}ej (9 i ce Heat Source: ❑Gas ['Electric ['Other <br /> BUILDING USE: ❑SFR ['Townhouse ❑Duplex ❑ADU El Multi-Family-#Units: commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ['Remodel 0 Repair RT.]. OSign ❑Sprinkler ['Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> -Cr_ of 7l 7...1 63 F-g <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 /> 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,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 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 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 /> PERMIT# <br /> OweFtie,u0vcrrized Agent Signature Date (Revised 4/15/2019) <br />