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imm PERMIT APPLICATION IIE <br /> 1112 <br /> BUILDING / MLHANICAL / PLUMBING / SIGN / SPIINKLER/ 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: et t,16- Cltve 414 I Ave, Ever tf Ws ?1 0 O/ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Vt I P C (f i f?,Ra--. TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: r p(--rq 5 I- _If 20 z- J <br /> CITY `2 �'Cp ,/J STATE /LL(/Z( /ZIP 2/0 <br /> OWNER PHONE: CO - �j iCC/ -3 OWNER EMAIL: ✓//Git`4,7l1 f7(' !/i 2 CL nl Y�l(r/.C�+-2-v, <br /> CONTRACTOR NAME: 5 P <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 'OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> OL)Kila-- CONTACT EMAIL: —_____ <br /> - -c._,,,,,, <br /> BUILDING INFORMATION -_ ` <br /> Existing Use of Building: Contract Price of ork:$ <br /> Proposed Use of Building: ff Heat Source: OGas Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex IADU OMulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition 0 Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 5 )1 . / f-d ,x,�. Q.c e SS o ,y i)w.z 1(rv� 0 0 r - 1. o-j--it ivt -/co,' i j <br /> - WY Sift LJiT( 1a, AlIL <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 /> NC-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) j Shower,Tub,or Combo <br /> Boiler Gas Range I Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer • Heat Pump&Ductless f Dishwasher a Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) •) _ Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> a Exhaust Fans(Residential) Commercial Ventilatior\ Floor Drain I Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) j Hose Bibb Urinal <br /> Exhaust Hood(Type II) I Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> 1 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/InserULog 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 /> PEII�#(A <br /> -..,-1--"_17_-_-_,---- q74//q CCA —(,0°R) <br /> Ow er/ uthorized Agent Signature Date (Revised 4/15/2019) f\['�' <br /> l Z <br />