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EVERETT <br />WASHINGTON <br />PERMIT APPLICATION <br />BUILDING WCHANICAL / PLUMBING / SIGN / 011RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 1023 100th ST SW, Everett, WA 98204 <br />1PROPERTY TAX #:28041300301400 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: RVHardt Properties, LLC TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET7714 78th PL NE <br />c,T., Marysville STATE WA z,P 98270 <br />OWNER PHONE: 425-330-6753 <br />OWNER EMAIL:rvhardt@yahoo.com <br />J CONTRACTOR NAME: Cc C o tLL 7 5 , 1,e ee Aci i <br />011 <br />CONTRACTOR ADDRESS: STREET /� 'a e 51 e 3 Z/O l37 r'' A� /E !I/� <br />CITY /, a / �I� - 1e' 41e m , STATE 4411/T ZIP C E 2 5 <br />CONTRACTOR PHONE: L-125-33-'1­526000NTRACTOR <br />EMAIL: ctCpttj moo. RUC LC'/ s7 c�: ijp !}�Ct� G<��' <br />CONTRACTOR LICENSE #(REQUIRED): J71)L'O 8 / / (% Jr `f" <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): r1- y2 7Z <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: P % L <br />r\ 1e";%� /�arGl 7 <br />CONTACT PHONE: LfZ E - ?> eQ7 7 5T <br />/6 <br />CONTACT EMAIL: I <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: jA/ <br />Heat Source: WGas ❑Electric []Other <br />BUILDING USE: COSFR []Townhouse ❑Duplex ❑ADU []Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair LIT. 1. ❑Sign ❑Sprinkler Demolition ❑Change of Use <br />DESCRIPTION OF WORK: //� / -/ ��L�y / <br />EX.<' 1 S,=R any/ � GvIP� Qrc{� Ljq/ lbe Ri�ih�S4t� a5 <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C - Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />lDrinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type I) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type ll) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />10ther <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />I <br />1 <br />1Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />I <br />INo. of Heads <br />Chemical Suppression System <br />I <br />I 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 />146'���� 2 D PERM�2_OM <br />— V <br />Owner/Authorized Agent Signature Dbte (Revised 1011012018) <br />