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` OINE • PERMIT APPLICATION
<br /> n.
<br /> BUILDING / MECHANICAL I PLUMBING I SIGN I PRINKLER! 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: 1 '(r PAP:' ,t„ ,5?, ZL.S)(a. it/ IOPERTY TAX#: ` ` O 5 `` O 0 1 O 1 10 0
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME:MM\i t -tptc 41,111Trifkrapj Pik NA L P TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 7 J 0 /(;F Thi 4 1,1' SIT r 4i
<br /> C STATE dk ZIP '-1
<br /> cm( � $°F"�'w�,�,� � �; \0 `i
<br /> OWNER PHONE: Z c�a '? 5 7 ii, 1 OWNER EMAIL:
<br /> CONTRACTOR NAME: o)a I)) 1 ,,'',4; ,` I VQ,
<br /> CONTRACTOR ADDRESS: STREET 472,9 0 fiii 6 /iJ0 A/ $i. V.Q s-r-E .5
<br /> CITY _601-,4 `f>,.! 1°r9/ STATE /7) ZIP Q , F/ci
<br /> CONTRACTOR PHONE: Zvi: ¢ ' :,, -0 ; CONTRACTOR EMAIL: Of F/ (..: ,.4L,L, 're tit1C;_[o/el P
<br /> CONTRACTOR LICENSE#(REQUIRED) .`.i _`l,.1-,119 q c j,Gk. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 2..3 i 9
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2 O 6 -.% `z,_0 C?t 1.
<br /> Ni)4'11..1,.\? 1:,0‘.!fiD CONTACT EMAIL:
<br /> .'to' , ; ,1 M.
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: ,; ,s ."";` = s "a";a Contract Price of Work:$ /2 c/,j 2 _ __
<br /> f
<br /> Proposed Use of Building: !1'r t 4, A r.;O't t f,/ Heat Source: ❑Gas ❑'Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse El Duplex ❑ADU lluiti-Family-#Units:' ,'i- ', ❑Commercial DAccessory Structure
<br /> Type of Project: ONew ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use '
<br /> DESCRIPTION OF WORK: {"as ',A,t a c..)s ki58 /3 t..; a s `)7, I i 0,l ti . 9 Z t 1 cc . `7 0, ;''. t "" C; 7 t
<br /> ANC _a -''. t(<5,5 g57 Pl 0
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): f`N lig.
<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 /> NC—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(kemodeO 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 J 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT46 2-On 1 On
<br /> Owner/Aut oriz' Agent Signature Date (Revised 4/f5/261 01 )
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