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INM PER ,IT APPLICATIO <br /> liz III <br /> BUILDING , MECHANICAL I PLUMBING I SIGN P,-INKLER I 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: -63C evre--0 Wry g PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: te,ti LA I rvh (u I vtw3rl-wt,o+ LLC' TENANT BUSINESS NAME(Commercial): .j I Stvy.e__ <br /> t-jOWNER MAILING ADDRESS: STREET e'�3-b yt (,.1f� Q <br /> CITY 6t,€V4_ STATE ZIP <br /> • <br /> OWNER PHONE: Z'5 — yy- 7s''Y OWNER EMAIL: L J 2. ES imE L LC.. € A i(. Liz ,‘ <br /> CONTRACTOR N <br /> AME: ,'uh,k__ (--:;i, S (1,, ,lti• USYar Ih1C.) <br /> CONTRACTOR ADDRESS: STREET I J Il k. 4.-I\2,' 161 <br /> CITY L1 v\V`1'v0-.3C1 STATE LAA ZIP 1�Z71"3 <br /> CONTRACTOR PHONE: `./ - 7Y�-j-i j CONTRACTOR EMAIL: j 4,r, y„ t.legi ,S . <br /> CONTRACTOR LICENSE#(REQUIRED): J tit TT E- 'A L 17 c„c_ry CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):L.S-I - CS'C <br /> PRIMARY CONTACT: ❑OWNER (p CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: y25--2 — O74,0 <br /> e;,)eye_ ; ,,t„) CONTACT EMAIL: , tik, 'Tr3 . -I— <br /> BUILDING INFORMATIO J <br /> Existing Use of Building: Contract Price of ork:$ :=)L:'t <br /> Proposed Use of Building: Heat Source: Gas 0 Electric ❑Ot er <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ,Commercia ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition DRemodel ❑Repair ❑T.I. ylSign ❑Spri kler ❑Demoli' ❑Change of Use <br /> DESCRIPTION OF WORK: ISl-�- r <br /> )1 5 �`� -.�� &_, ��;w �,,. L ,r70(� `--�' <br /> v, <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 I 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 UseOnly <br /> —/. � I� ��y / f PERMIT(n'� i� ( /l I <br /> Owner/Au ririzeent Signature Date (Revised 4/15/2019) <br />