8823 HOLLY DR 206 BLDG A 2021-12-17

PERMIT APPLICATIO BUILDING /MECHANICAL/PLUMBING /SIGN VSPRINKLER/DEMOLITION 411111 CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue.or Black Ink Only Please) / f/!J PROJECT SITE INFORMATION 7 /74 PROJECT SITE ADDRESS: �T 3 D r /7-i27 PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision ( Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: /9)5b-2._ f� t TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET G7 (:Z j i-71616/ br /1-,2 0-6 rVevvA".)— CITY ¢ STATE V _ ZIP OWNER PHONE: 2Q 2/�—(�,3Si J OWNER EMAIL: CONTRACTOR NAME: ,947/!1 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(RE .UIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify �, CONTACT NAME: CONTACT PHONE' h� 2 / L L CONTACT EMAIL: 1 ' BUILDING INFORMATION JJ Existing Use of Building: Contract Price of Work:$41" 1'e J G� q'i Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: CI New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ODemolition El Change of Use DESCRIPTION OF WORK: 92104/'n ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION FixtureFixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C–Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/'`SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression S : - No.of Heads ACKNOWLEDGEi• T:1 h. e reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with current feder• fate,an. ocal law.The granting of a pe..t-only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building••cial before.eing authorized under-•• ircumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and I imply with t State Contractor -w 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PE7 kiCt " 002 0 /Authorized Agent Signature Date (Revised 10/10/2018)