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= PERMIT APPLICATICO <br /> BUILDING / MECHANICAL I PLUMBING /SIGN i SPRINKLER I 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: to 1 Z 1 a Q<-' ztN1 *Col Z-T, PROPERTY TAX#: 2:8 04-2-4CO2.00\OG <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1afn fZ.PcU CA'iT`( f\'ZZA TENANT BUSINESS NAME(Commercial): P 1ZZi\ 14) C t4 <br /> OWNER MAILING ADDRESS: STREET 1'2121 r 1 o3a 5 1 Zoo CITY M1, 1 L-T1�O STATE �'V'� ZIP ctS2:-7 5 <br /> OWNER PHONE: 4 -'3 4.1'6 - if%7T EXT 3ccoS OWNER EMAIL: C-i-1 nLb .jt:N E-IN RAI.PG`"*NI 1ZZ4. •C:G1fr1 <br /> CONTRACTOR NAME: P(AmOr11 C.ON51TZL'C:T IO N Sec iC <br /> CONTRACTOR ADDRESS: STREET 54-2-0 N1L TN2-'j S G� p <br /> CITY 'ITV F, STATE W A ZIP 1 M cyo <br /> CONTRACTOR PHONE: ti53-791 - 3�5 `T CONTRACTOR EMAIL: b/ 1.-Fl @ is AST. <br /> CONTRACTOR LICENSE#(REQUIRED): D i AMID CS 9 S6.3 2 CITY OF EVERETT BUSINESS LICENSE#(REQUI ): <br /> PRIMARY CONTACT: `,OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ' 36 - 423 - C 59e1 <br /> C.1-kUCW- EN17tgSC4 CONTACT EMAIL: CA-tEN i2-SC c� Q( PLPC-Ty Fizz Cct'A. <br /> BUILDING INFORMATION <br /> Existing Use of Building: IZ T(S.\L '511 ' Mi-.'A Contract Price of Work:$ >00; <br /> Proposed Use of Building: 4' /peuv' :y Heat Source: ' as ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex OADU ❑Multi-Family-#Units: commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair '6ZT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 2 1-NoW9 (1"'9' S. ) Ptty� <br /> 1 M.p.*- u P PA P- 1.)is 11" <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Count Cou Count Count <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 Ventilatior 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.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 /> " 1\1\. 1-A) L11 PIZZA) I.Lc� PERMIT# <br /> e&tc1h 4 vyu—.__. 9-6-99 IX\\ 0c\ . CA 0 <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) <br /> 1/.y <br />