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MINI PERMIT APPLICATION
<br /> 112
<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 /> (WOO or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 1012 c I S{ CXf-. � E. 1:v etc t (,.J11 (6 ZO (4 PROPERTY TAX#: '7)3),
<br /> LEGAL for new construction: Short Plat/subdivision ?1"/\( SS 4 - Z 0 5 Lot No. 2. (attach copy of long legal description) '(es
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 1401,ii.‘in,':= I' I'w i•viC FIvt GG 1'. A L TENANT BUSINESS NAME(Commercial): E(,JA
<br /> OWNER MAILING ADDRESS: STREET Li k ek i2 4 ay St . S-E .
<br /> CITY ev C.Z- i\ STATE WrA ZIP C N 2 0
<br /> OWNER PHONE: `LAL \: 23y- i zy OWNER EMAIL: RA,0%�oQ•.1.e- 301.,hlsc t`� ••CiDrill
<br /> CONTRACTOR NAME: t � y r " er tO '.---C-11 L. 210(11144I ► 1/lM C t' "d
<br /> CONTRACTOR ADDRESS: STREET ' 11 01 IpN,L. (s-i.e" int,,ucv) ,(•• - *601 1,, 011
<br /> CITY .P-L-V-(1'z, STATE (1)A ZIP 103
<br /> CONTRACTOR PHONE:(2..1,4-i..)_.—3(41)_f,_40- .� CONTRACTOR EMAIL: - Ke,P1 s iev--(w M<(I , L,i e,y1
<br /> CONTRACTOR LICENSE#(REQUIRED):jr1� -(t-- \t' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �—
<br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) *klibl(go
<br /> CONTACT NAME: k CONTACT PHONE: L1 ' 2 CV- get? -\
<br /> Rock N00,P1 CONTACT EMAIL: fU& `uc::1 ,.1 ci l vim\6C o 1 L�1 . ( 0 Yv1
<br /> 1 // /� 6 i%! t%� f' ii ■gyp NGU %//i ,,,; % ,,, /�j i. .r',:' r r/r r�r
<br /> :/ ////�/ /j„ /�j%r' /; ��ir 4;M11�1�- �1�'+KRj..,r!►.TIVNI�%, i //i � / s /
<br /> s�
<br /> Existing Use of Building: Contract Price of Work:$ 3 2 , S 23�.
<br /> Proposed Use of Building: 3 N K Heat Source: ❑Gas ISElectric ❑Other
<br /> BUILDING USE:3N(SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: [2 ew EAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> At.v-1 51'i ,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> r/ems,, % '/ j / �W,: /�/.%✓ 4i i�ir r r,�; ri/, r r' '',f '
<br /> MECH NICALI'ERMI APPLIC''A'TION /%' !r ' <PLUMBING"PERMIT AP*ICATR) t
<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 I Backflow Preventer(Inside Bldg) 4 Shower,Tub,or Combo —
<br /> Boiler 1 Gas Range ,Z Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> 2 Clothes Dryer ( Heat Pump&Ductless i Dishwasher S Sink-Residential(kitchen,bath,bar) •
<br /> Duct System(Remodel) Refrigeration Drinking Fountain ( Sink-Utility,laundry,mop
<br /> 5 Exhaust Fans(Residential) Commercial Ventilation Floor Drain i_ Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) . Hose Bibb Urinal
<br /> Exhaust Hood(Type II) 1 Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> 1 Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> I Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains r r
<br /> ` S NKL I SUPP ESSION S AEM % ;'' Sewage Ejector or Sump Pump Other:
<br /> W ter re ion S stem i( o.of ea s O ,(/)emit uppr n Syste . f Head ,i
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained hereinV 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 1 am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the State Cont ctors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> [P;rMI #
<br /> Owner/ orized Agent Signature Date (Revised 10/10/2018)
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