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• 111) <br /> MINI PERMIT APPLICATION <br /> LI <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WAS HINGroN (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: 10 q 37e.Yc,Y PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ___ CONTACT INFORMATION. <br /> OWNER NAME: //r_A`n s lG,,, /1a.7 4 TENANT BUSINESS NAME(Commercial): Sy- yrB Ciao,4. <br /> OWNER MAILING ADDRESS: STREET 6 <br /> 7 CITY STATE ZIP <br /> OWNER PHONE: 1(25-7` , %'7Cf 7 OWNER EMAIL: iti eLZCof /(4 e G oa r ca-y f,oe_r <br /> CONTRACTOR NAME: [JO/ten 9k.,/o/ y GO/I ttq'c-h' " <br /> CONTRACTOR ADDRESS: STREET 'f2!G /r!'d w 4, vri'?c, <br /> CITY Ala eur7'f P'P4 m STATE (,/,- ZIP 9i'a27)‘e,CONTRACTOR PHONE: j� -9 ye2-7'f j O ' n CONTRACTOR EMAIL: D-402 0.40, 16,01 131. '._.. <br /> CONTRACTOR LICENSE#(REQUIRED): J3O/is b G YO 0(414- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): a Q 7 <br /> PRIMARY CONTACT: 0 OWNER CCCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 36 ' --9 z _7st70 <br /> J 041 Z Y g'yAP_ CONTACT EMAIL: a ze..4 tea„ 1_4._ G 21Q.;I <br /> BUILDING INFORMATION <br /> Existing Use of Building: Aftd-6' "te4,'f Contract Price of Work:$ /S021000 <br /> Proposed Use of Building: 5-f/-1/7 pull Heat Source: Gas DElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse EDuplex ❑ADU ❑Multi-Family-#Units: `Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair (Vj I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> caw Vei t>'.y T 1 s p e t i fe m' iL-w fLc-yvo esfr -' n <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 132CO3 —o3, \t):(11,-7 4.-.) nr- ,..10% „Oe <br /> ,MECHANICAL PERMIT APPLICATION QUMBING PERMIT APP, ATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> Air Handling Units I Gas ' 'rr cw Backflow Preventer(Inside Bldg) Q Shower,Tub,or Combo <br /> d Boiler as`�2ange t� Clothes Washer Cato) Sink-Commercial(3-comp,prep,floor) <br /> O Clothes Dryer' Heat Pump&Ductless a Dishwasher >-�-� Sink-Residential(kitchen,bath,bar) <br /> 6 Duct System(R e Refrigeration ( Drinking Fountain , Sink-Utility,laundry, op <br /> ® Exhaus an (Rid Commercial Ventilation Floor Drain I Toilet <br /> I Exhaust lko el) I�, (Not Heat/AC system) Hose Bibb Q Urinal <br /> ,d Exhaust H .--(type II) I er Heater / Interceptor-Grease PO Waste/WaterPiping Repair <br /> O Exha ood(Residential) _ 0 Wo ye 4 Interceptor-Sand/Oil 0 Water Service(behind meter) <br /> I ed Air Systems -. V' Other. N 0 Medical Gas a Water Valves or Fixtures <br /> e Gas Fireplace/Insert/Log CT Roof Drains I Water Heater <br /> ;SPRINKLER'!SUPPRESSION SYSTEM', p Sewage Ejector or Sump Pump Other: <br /> Water Suppression System 1 Aft No.of Heads /'�It� <br /> Chemical Suppression System /v 7 No.of Heads /�!' <br /> ACKNOWLEDGEMENT:I have reviewed this application and cpnfim7 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.lam 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. RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> uthoriz Agent Signa Date (Revised 10/10/2018) <br />