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MI • PERMIT APPLICATIO. <br /> MN <br /> BUILDING /MECHANICAL/ PLUMBING/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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: S70Z 7.1-k. Avenue_ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: rV E(Z "T j-j-COS D j c,tgI CT" TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 5100 15F-0A2 WAY AVM c <br /> CITY ' l/W •TT STATE WA ZIP It?el <br /> OWNER PHONE: 4 Zsqq s --1O(�Q OWNER EMAIL: �I(,(,I kG� (�CGS eVe,re k� , o c <br /> L <br /> CONTRACTOR NAME: 13C (0I/14c7fi''✓G tj 0 <br /> CONTRACTOR ADDRESS: STREET 6, Z4 17a r ii <br /> CITY 5rj EVOE.. STATE )A)/4 ZIP ,etvg <br /> CONTRACTOR PHONE: 206 "43-—7746 CONTRACTOR EMAIL: Meir 0 4 AA VI @/a rgon ber(-gcrcc , tam <br /> CONTRACTOR LICENSE#(REQUIRED): 1- 'gCOC- S3 II!Y _i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ` ' 7 )6, <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR j2rOTHER(Please Specify) A hGk..t 4-6 <br /> CONTACT NAME: /r l I^c ' Vva 11 Cr 'CONTACT PHONE: 4 5--ZS l _ 00 C 0 1 <br /> 51PI Arc 2 CONTACT EMAIL: / , <br /> c°�S vI� des(;s(°' lam.�► ewe, Cohn <br /> BUILDING INFORMATION <br /> Existing Use of Building: SCheai Contract Price of Work:$ c/e/2STO <br /> Proposed Use of Building: 5G I Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU DMulti-Family-#Units: DCommercial ❑Accessory Structure <br /> Type of Project: ❑New DAddition 12emodel DRepair ❑T.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> AetiviC s vl Ts.) Wot��g aw 3 Guars i k <br /> et� auto 1dbhyfor �ccciry. <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 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 I 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 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./ City of Everett Official UseUsse Only <br /> Zitia/6 / PERMIS(A� D ` l <br /> ner/Authorized Agent Signature Date (Revised 10/10/2018) <br /> /2— <br />