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40 PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ 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 /> (Blum or Black Ink Only Plus.) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:102/0 jEVERGREEN wiw EVQE7T WA 9.'3°'/ PROPERTY TAX#: OO53520000060/ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: EVERETT /Ai1VS LL-<- TENANT BUSINESS NAME(Commercial):ex-6447/UE PZt;S t OENGY <br /> OWNER MAILING ADDRESS: STREET 5OO /sera s7 Sw 67e/x./ <br /> CITY LY.VNV✓©0I9 STATE WA ZIP 9 37 <br /> OWNER PHONE: 1'125 Lio9 6 I q5 OWNER EMAIL: +I'M e.360 ho 17/Vc/O . e o,av1 <br /> CONTRACTOR NAME: HEAT/4 AioartIWar <br /> CONTRACTOR ADDRESS: STREET 27/O /O`f n/¢ S7- C.7_ <br /> STATE-- —�'- -- SIP- 8-z/-97 - ------ <br /> CONTRACTOR PHONE:2553 #95 7091 CONTRACTOR EMAIL: bbro54e.4 e., 00,/'11,wee-i- C=0n7 <br /> CONTRACTOR LICENSE#(REQUIRED): f/(A7f/4/..798/Z E CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 1f I617 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2553 4 c 5 7©rt f <br /> Bz IA N t3ROS /AWN CONTACT EMAIL:b�r ^fin ,41 v1of-Pi wes4-(oM <br /> BUILDING INFORMATION <br /> Existing Use of Building: I6kI ko77L- Contract Price of Work:$ I ao0o, 00 <br /> Proposed Use of Building: 1-1o76 L., Heat Source: OGas ❑Electric ❑Other <br /> _ _ BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Zcommercial ❑Accessory Structure <br /> Type of Project: ONew UAddition ❑Remodel El Repair ❑T.l. Sign - Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: pjpocCE Sitar) rkCES /AJ CO Ewsn'u& ,vl Ou,v/v►E,t -r E/GNS� ©rvLy� /,ti 7Art,L (1-) <br /> sjp /"-I'MINA7EO Wh GNS Z( 0i/vb " A.Ye6u riVE (Ze-A OENG`/ BY l S7 es-peL" <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 /> A/C-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 I 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.1 am the owner,or lam 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# �^ z O 4 _ 0 ©g <br /> '/ uthori ,i�,'7 ignature Date / (Revised 10/10/2018) <br />