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0 PERMIT APPLICATION <br />BUILDING /MECHANICAL /PLUMBING /SIGN /SPRINKLER /DEMOLITION <br />EVERETT 32CITY OF EVERETT PERMIT SERVICES <br />00 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P)425-257-8810 1 FAX425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />/� <br />PROJECT SITE ADDRESS: 103 -7 �` \ UF— &- A4 _F- I-�) <br />I PROPERTY TAX #: 0 0M 33 G b O L I q 6 Z <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: I ly S i3 cS 1 TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET % 0 3 C' <br />CITY l �,/ L �. Tr STATE 114 I ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />y <br />CONTRACTOR NAME: S7— FIR 5'CIL-0T"1 UkS LL G <br />CONTRACTOR ADDRESS: STREET y Z7I C) l� c3 � UJZ (/ (,C.�/'� , ST C <br />!� � <br />CITY A U �-j Ci � /—I STATE Wfi 71P f V V <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: �j tclG, Ci2<s1oz 1/je,S66I,7-/U <br />CONTRACTOR LICENSE #(REQUIRED): 1,57— T 586, J% <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER `CONTRACTOR ❑ OTHER (Please Specify) ! <br />CONTACT NAME: <br />l c (!13 L /2& EdZ <br />CONTACT PHONE: <br />CONTACT EMAIL: �7 I C!Z- o _�C%ZCi7 —L //(fir oGu7-1 olds , GG <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: CLU -3 L' <br />Heat Source: ❑Gas ❑Electric []Other <br />BUILDING USE: OSFR [-]Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New gAddition ❑Remodel ❑Repair ❑T.I. ❑Sign Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />S?F-(Aj lcLl�y !/j hlCyj Apt)rri`/ <br />7 s X-5 &� <br />ASSOCIATED BUILDING PERMIT # (if applicable): nil <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C — Air Handling Units <br />Gas Piping <br />Backflow Prevent (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type I) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />I <br />10ther <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER I SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />42 <br />No. of Heads <br />Chemical Suppression System <br />No. of Heads <br />ACKNOWLEDGEMENT / 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. / am the owner, or l am authorized by the owner of this property to perform the work for which application is made, <br />and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />b-f-2vZc> <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT ^ , �^ I <br />(Revised 1011012018) (�J( <br />v <br />