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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4fErr 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECTR SITE',INFORMATION <br /> PROJECT SITE ADDRESS: 7 tj UJ-es <br /> r-k- t c SMo lQ Y62 PROPERTY #: "vl/ G l <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy Tong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: vIi5 Cory\ run TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET W" 4 &Ls r c <br /> CITY .5,0 STATEy21-- zIPq tl 7j3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 1-1.e'im(A V UI\ <br /> CONTRACTOR ADDRESS: STREET �7jJ Zhd Y�I�L 10 <br /> CITY c.��' . STATE tAYR ZIPC1 Z5D�7 <br /> CONTRACTOR PHONE: 25, (CC? CONTRACTOR EMAIL: J (wQ . t3� � B 1 04ryyjr ovi CGiy� <br /> CONTRACTOR LICENSE#(REQUIRED):1-E V Y �t S CITY OF EVERETT SINESS LICENSE#(REQUIRED): 0 2 /ZOZ. <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT, NAME: CONTACT PHONE: 2.,6 71(�7 <br /> K A (9) 1L 4Vc ISUA CONTACT EMAIL: r� N.e(air) worng nc-e am <br /> BUILDING INFORMATION �2 <br /> Existing Use of Building: CCO1 YtAiNk 11Y VIJ [J)L Contract Price of Work:$ 2../d i c <br /> Proposed Use of Building: C-PNIYI P Ack.,\I YVJ.A (ttA Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: CI New ❑Addition &Remodel ❑Repair ❑T.I. CI Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> WOOS O IPS-V Con 'Re_Oac e-r1k <br /> ASSOCIATED BUILDING��(�app- Rca r): UN�'� �C/��lM�` 1 ► `tom <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures court 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 q Other: Qj -(.) Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log 'uG}Ay'i,( 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 /> li \\ PE 0 - �S <br /> Owner uthorized A ignature Date (Revised�10//110/2(011{88) <br /> i <br />