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Em PERMIT APPLIC N <br /> izi <br /> BUILAG / MECHANICAL / PLUMBING / AF1 /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) 1 PROJECT SITE INFORMATION 2ci©So C1 f)t)3O Op <br /> PROJECT SITE ADDRESS: l(00l (V'BYL.SI'DE ROAD PROPERTY TAX#: zips DbCOt{AL(r"' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: PA owl 'DV j NEo j• ec 401 TENANT BUSINESS NAME(Commercial): C;:Vtp .S <br /> OWNER MAILING ADDRESS: STREET gcv S-„til ibj jr ‘ S v 0 <br /> t 1� 3' <br /> U CITY l�-e!�I STATE 1N r I ZIP 9n(�7 <br /> OWNER PHONE: 2_5 , — nib_ OWNER EMAIL: PgjG..-IL e PdIt94 --i r`'I r)r044 <br /> CONTRACTOR NAME: p,ftj`f,s@ Ni 1a C�.��Yt." ,ii 'eW j,Nt,VVi i)`*lit <br /> CONTRACTOR ADDRESS: STREET I5223 1D I-1-4 S.7LL`�`T 1•5.,;)T(E )1-10 <br /> CITY 2 Jp� STATE �/�1 A ZIP yw�Z <br /> CONTRACTOR PHONE: t2 5 1'i-1 cj2 `L CONTRACTOR EMAIL: AOD 1 F e_ph 5 ,'N (. L.\ <br /> 7 <br /> CONTRACTOR LICENSE#(REQUIRED): ?KIT'/ ,C61) -1 C`Z CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 010 <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR CROTHER(Please Specify) Lt4 - C `tLL au rA61ni ,,n�VC., <br /> CONTACT NAME: CONTACT PHONE: Liz 5.A 31 /l7 si k 0 <br /> VL -2t") ,Mtt-L _ CONTACT EMAIL: C0?pE1/4C,P r.:_eimiL, c0.' \ <br /> BUILDING INFORMATION <br /> Existing Use of Building: tI(P Contract Price of Work: $ 1-0 ILOO co <br /> Proposed Use of Building: S•- ( !APt) Q-\ Heat Source: 4Gas DElectric DOther <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: lit Commercial ❑Accessory Structure <br /> Type of Project: ❑New DAddition DRemodel DRepair NT.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> m " (0.0 0,JD W0r2..x i Vtov t A- t N riltt m , fiictvitS <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 t Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless I Dishwasher ,5 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration 1 Drinking Fountain , Sink-Utility, laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Lj Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb t 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 I Water Heater f1,,W('.\V <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDG MENT.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, ate,an 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 efore 'ing authorized under any circumstance.1 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 h the S to Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMITplat 11 r 0 � <br /> f1 .Z� .I yr� <br /> Owner/ uthorized ent Signature Date (Revised 4/15/2019) <br />