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Mil <br /> • PERMIT APPLICATIO• <br /> Ira <br /> BUILDING / MECHANICAL/ PLUMBING I SIGN /SPRINKLER I 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: . 2- N C i3'4...L AVE,, PROPERTY TAX#: C.C.A.- ]C)iv 6Gsj 1 i C <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Ft.iti. 'rwe 1 i IUS:STIktekrL TENANT BUSINESS NAME(Commercial)..` Y, sMu . <br /> OWNER MAILING ADDRESS: STREET PO 03S. S4651 ^` <br /> CITY 2\J STATE - j ZIP eok, <br /> OWNER PHONE: t t 7C74 • 070 0 OWNER EMAIL: ire 1,1t\\ : dire jvl vesk Wt-e44.e(Y <br /> CONTRACTOR NAME: 4A.NE 0 (z ?G a c). ( , c_.. <br /> CONTRACTOR ADDRESS: STREET '1627- 'POW L:e41--- AU6 <br /> CITY Wel4,P7Ti W'Pt STATE cr2j0b ^^ ZIP <br /> CONTRACTOR PHONE: A2 5 543 <br /> 6 I2� e CONTRACTOR EMAIL: saw-the C'©G.Y'GLjAier <br /> CONTRACTOR LICENSE#(REQUIREG 1�tilJNb OC:_ t C1 3v CITY OF EVERETT BUSINESS LICENSE#(REQ D). (/ <br /> PRIMARY CONTACT:M OWNER ❑CONTRACTOR 0 OTHER(Please Specify) 0 6)0 1 -1-M Ct 2.4 <br /> CON TART NAME: CONTACT PHONE: 42 - 7;4 ... 070 0 0 <br /> T EU, 6,E--Vj( tj'{ CONTACT EMAIL: u s al,p <br /> BUILDING INFORMATION <br /> Existing Use of Building: bA1At1,(. Contract Price of Work:$ 6/ Z`7C'• t s" <br /> Proposed Use of Building: /\-fietoU Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: AfiCommeroiat--fp-Accessory Structure <br /> Type of Project: ❑New ,,BAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> L1 rttc 1.ur► z -'411-c Si: ijoNiZttetiSE / DITlb l .)- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION ---' PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture �/' <br /> List of Fixtures List of,Fixtures List of Fixtures List of Fixtures" <br /> Count Count ., Count Count <br /> A/C—Air Handling Units Gas-//ping Backflow Preventer(Inside Bldg) Shower,Tub, ombo <br /> Boiler ,zeias Range Clothes Washer Sink-Cor tmercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sir�k-ffesidential(kitchen,bath,bar) <br /> Duct System(Remodel) /' Refrigeration Drinking Fountain ..-84ink-Utility,laundry,mop <br /> Exhaust Fans(Residerliatli Commercial Ventilation Floor Drain ,,,,,,%t Toilet <br /> Exhaust Hood(Typ , (Not Heat/AC system) Hose Bibb ,,. Urinal <br /> Exhaust Hood(T e II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hoo esidential) Wood Stove Interceptor-Sand/Oil -' Water Service(behind meter) <br /> Forced A' ystems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drainsz7 Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM ,Sewagekrector 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 /> PE'�` T <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) Ira <br />