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MEM • PERMIT APPLICATIO. <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 l www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:11014 19th Ave SE#19A, Everett, WA 98208 PROPERTY TAX#:28051900400400 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): Bims Laundry Cafe <br /> OWNER MAILING ADDRESS: sTREETC/O David Swissa 2404 137th PI SE <br /> CITY Mill Creek STATE WA ZIP 98012 <br /> OWNER PHONE:425-503-4714 OWNER EMAIL:davidsWISSa@hotmaiI.COM <br /> CONTRACTOR NAME± ho furnish !atv;--CP)A J\- 1 ;v <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: , � s LL,i 5 S0. CONTACT PHONE: 4,25 50 3 1-1 1 )L.1 <br /> CONTACT EMAIL: l9 a4tSUS v-' SS {`,-/�G>L- el • �v <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ •",9'3 0 — <br /> Proposed Use of Building: same Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ElDuplex ❑ADU ❑Multi-Family-#Units: ©Commercial ❑Accessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair T.I.© Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> i7e e V c�' < .5 p-Ge 4-o 4.S I-A.I I c._J b e /: 4--e re,n. f <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 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 /> }r- PER # <br /> Pr-e$„(1 11/12/2019 \ck ,... 6 <br /> Owne uthorized Agent Signature Date (Revised 10/10/2018) <br /> l2_/� <br />