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fr <br /> BUILDINGSECHANICAL/PLUMBING/SIGN /SAILER I DEMOLITION <br /> R E E V ECITY OF EVERETT PERMIT SERVICES <br /> G Y G I[G 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: 101 O3 a Vey-green 1 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: - TENANT BUSINESS NAME(Commercial): (z44e A6 <br /> OWNER MAILING ADDRESS: STREET I610 3 ."ye,Y',C7(rpep') �[ <br /> CITY Gvere �,J STATE VIA- ZIPCTS/r�,.r0-j <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: '5 66 ± SLLyY' S i 1C'e,S <br /> CONTRACTOR ADDRESS: STREET f(Q 212 B^c-e r' 4- t e-1-1-- >j F2.31 • <br /> /y <br /> cry �(It Ct`Q� STATE A) - zw ( ?0I L <br /> CONTRACTOR PHONE: /25. 3 30 , /IDO CONTRACTORy EMAIL: �7'-f 5 t 9t . n•C d Y n <br /> CONTRACTOR LICENSE#(REQUIRED): 6131 S1.S*q q0-ft21 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 1 d y <br /> PRIMARY CONTACT: ❑OWNER %CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: Rang.. CONTACT PHONE: 425. 3330, S i 60 <br /> CONTACT EMAIL I : ` mo .( TY"1 <br /> BUILDING INFORMATION <br /> Existing Use of Building: (.4,011)merc la I Contract Price of Wor•.$ S 600 <br /> Proposed Use of Building: 7 /4 Heat Source: OGas ❑Electric AOther <br /> •BUILDING USE: ❑SFR ❑Townhouse EDuplex OADU OMulti-Family-#Units: V.,. ercial OAccessory Structure <br /> .Type of Project: ❑New ❑Addition ❑Remodel DRepair DT.I. '0 ign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: in3 ', `I) tD skgn dISQl&1 <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 ventilator 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.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 9 PET# ) 0 <br /> 1Deg .......09 <br /> 0 >r . ak <br /> .ent Signature Date (Revised 10/10/2018) <br /> 17i <br />