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0 PERMIT APPLICATION, <br /> BUILDING /MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> 441407-4 <br /> CITY OF EVERETT PERMIT SERVICES <br /> Ir1 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (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: 11( VIJ ,,,3 d -1 -- 6 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision 00 j't1'\()Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C,OrkS A-s:Sei , ,ei--C(UA TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 80), W C/1"e eci <br /> �V <br /> CITY EV ee-d--1 e. • STATE g ZIP °I1(1:20 Ci <br /> r,� <br /> OWNER PHONE: "l ol�� '361 7 (13 f �— OWNER EMAIL: <br /> CONTRACTOR NAME: _ .,yy4e_a - c, E,c5-ionfix <br /> CONTRACTOR ADDRESS: STREET 010/3(I'.1.. -C2-61^' a,,.e , <br /> cm( IC,er--A7 STATE W�l l ZIP / 1�✓�� <br /> CONTRACTOR PHONE: 01,53-a,3 6 -016 G T(CONTRACTOR EMA Cy(v b�ct) ,n 1)€<le(i t r E5-6, -a in,cor- <br /> CONTRACTOR LICENSE#(REQUIRED): , I PT Etta clash CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ,e0NTRACTOR ❑OTHER(Please Specify) 1-i r- (briSw eo-' <br /> CONTACT NAME: / f CONTACT PHONE: C)(�e�q(od e0 <br /> U <br /> /I CONTACT EMAIL: C)Jl,v�&e'10lil'�e�'�e d-zsiv v't,Ip -G0vv., <br /> I <br /> BUILDING INFORMATION <br /> Existing Use of Building: Re-MAA Ofax4 A—e,r)A Contract Price of Work:$_ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel_-epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> (��s-b io- dlA e -6-,.6 e <br /> Aemb4,1 4taboJ <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 /> 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(Remodel) 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 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.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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT ) <br /> q.CID —OD I <br /> Owner/Authorized Agent Signature Date (Revised 10)0/2018) <br />