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MIN <br /> 4110 <br /> PERMIT APPLICATION. <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: .6 61 I( oGfre 6 i IJg 0 PROPERTY TAX#:), p5O (]Q y 0 D6 JQ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION / <br /> OWNER NAME: 711K) ��1 1%NJ3 be,U e I 1pt,€hit TENANT BUSINESS NAME(CommerciaI) j'i')p r /CpNtE �I <br /> OWNER MAILING ADDRESS: STREET f00 S(A) (,6 `� - 1T ((( <br /> CITY RG/\14,941\ STATE M <br /> ZIP li eVn <br /> it‘fr <br /> OWNER PHONE: OWNER EMAIL:n 5 Et k 0l N l (),-- i ,C P^,, <br /> CONTRACTOR NAME: 1 I J IrC (..I© A ( V <br /> CONTRACTOR ADDRESS: STREET . 64}( 7 C) <br /> CITY E''U (' Giy STATE (,4 A ZIP ?Ko a Y <br /> CONTRACTOR PHONE: `,{)5 %6 i(iy t r'1 CONTRACTOR EMAIL:�i i(� ��i=YYYY �/i A� U Gt rM <br /> CONTRACTOR LICENSE#(REQUIRED): Al, (S TH Av y y 0 t\ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):, y S S 5 <br /> PRIMARY CONTACT: ❑OWNER la CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:L.' 5.' 76 6 f 9 y I <br /> PMRIJ1 COi\J J i\'J t' CONTACT EMAIL:f T'r ,r--.I/0-) <br /> r A I) f r 41 (_I 1)r . . Co dt'i <br /> BUILDING INFORMATION <br /> Existing Use of Building:OTC9 b (NA Re Nj).eS Q Contract Price of Work:$ <br /> Proposed Use of Building: rtcp. / <br /> W m p..eti 0'n5 Heat Source: as t i ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ElDuplex LIADU ❑Multi-Family-#Units: .commercial ❑Accessory Structure <br /> Type of Project: ❑Neggw ❑Addition_( Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler,1 ❑Demolitionn��❑Change of Use <br /> C 1TI NOA) K00c V�,/� C1 Eft,o �''u c (,ti s ( Ic 51Z, Naw' of i C(5 <br /> � h rvrl Pt kit) r�o� <br /> s--1.P,)1 Gros 134 po To N@ w 0 i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): IJ 11 Q -0�� <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 I 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 Ventilation 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 I <br /> Chemical Suppression System 'No.of Heads <br /> ACKNOWLEDGEMENT:I have r-viewed •' ... cation 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 - . T •granting o a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being:uth•r'ed under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the Stat. " on •ctors Law 18. RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> i PERMIT# <br /> 1 I ' L' M 11 V 066 <br /> Owner/Author ed Agent Signature Date (Revised 10/10/2018) <br />