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= • PERMIT APPLICATIO• <br /> 12 <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 151 L <br /> 9 1 3 r`LA STL 5 E " i F PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L.V kt ,J aChe_C TENANT BUSINESS NAME(Commercial): &/`1c' C L Lrs <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: i(412513 7-.; J.(95-1 OWNER EMAIL: a 0.Lh t C.1 J kL Gt�f4• • C o vn <br /> CONTRACTOR NAME: C r a.k4 r 1-t (-0-1, F/N.,J -. CJ <br /> CONTRACTOR ADDRESS: STREET 1 3 C z 5" 5 c,J Z ' s I- <br /> CITY BL'&vei-4-.v STATE D/Z ZIP 5700,9 <br /> CONTRACTOR PHONE: 5 0) 7?9 "7 7 52) CONTRACTOR^ EMAIL: d v -b,f�di Ly 0 5yyv a r /• Co,"‘ff <br /> CONTRACTOR LICENSE#(REQUIRED): C R E E KL. O 3 3 D 1 CITY OF EVERETT BUSINESS LI/CENSE#(REQUIRED) (0 Z Z 3 3 <br /> PRIMARY CONTACT: 0 OWNER j$[CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 513 7? '- '779/ <br /> D a r'1 13 r&oil 7 CONTACT EMAIL: dM►Gb fc,)ley 65/VW , /, C"" <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 79000• (-)-2 <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 7--.0^6.44 Lye,v?.,,,,,rt- n1od,,cy €y" J•'-+J 5 pd•c.2 • -0 '411r �j-t,c t- C I rS <br /> p\ -', ve4 ca•-7 --6,u, 1- was A- ht& 'r $t/.�, 1,,s�11 nr,.✓ '/ c pc.v•4✓/— A�N' <br /> 'CJrr..{vrc. <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 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.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 /> 7 /1 i/-, ,, PERMI9.j o4 I <br /> Da, Yam./ / <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) yz <br />