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4-77 . PERMIT APPLICATIONS
<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (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: 1717?$ Ocv--/;ell-6.-n L/v• Eve et/ I&4 PROPERTY TAX#: 00 Li/7/ 000O5/0(.;
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME:n--e eyv„--1 A- V. o bct r IA/e i eNfr-,.:.A.J. TENANT BUSINESS NAME(Commercial): N 1 0
<br /> OWNER MAILING ADDRESS: STREET 9 7 d8" h CA 6 i rke\-1-(r;,‘ I.N a
<br /> CITY FL)e(-e H STATE -, Vr 7 ZIP 9 aC
<br /> OWNER PHONE: t-'PZ S 0 `1 C) c OWNER EMAIL:�e d•e",..i.r,.f ei....,,e,,....(6,, .,-;r,,,,, 7• G c)s-,.--)
<br /> CONTRACTOR NAME: /V/iq
<br /> CONTRACTOR ADDRESS: STREET /r/�I Al /�
<br /> CITY /-)/,4 v STATE "T ZIP AT/A
<br /> CONTRACTOR PHONE: A'/ /"4 CONTRACTOR EMAIL: it///14
<br /> CONTRACTOR LICENSE#(REQUIRED): �f>11 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): N/i9
<br /> PRIMARY CONTACT: al/OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: tZr Z- -7 [I q 0 S
<br /> d'e_ii.tik.Li lA e 1 v 1 Li_
<br /> -C CONTACT EMAIL: JL reel,/.L•v e;,-1 kcl "34@ €7.1-r3,/,cp:..)
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: S/r7/e F-OP.-7,// e Contract Price of Work:$ �l— /6 e 60 0-- 0 O
<br /> Proposed Use of
<br /> Building:S';he/%' ? am/ r r /17 Heat Source: ❑Gas Lectric ❑Other
<br /> BUILDING USE: WSFR ❑Townhouse ❑Duplex DADU El Multi-Family-#Units: D�....,,Commercial ❑Accessory Structure
<br /> Type of Project: ❑New Addition L13i�emodel El Repair DTI ❑Sign ❑Sprinkler LKuemolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> ///4 r;7/cic L.7, v-1 ' /A-e c7(0 c.,�fr.:' C e c 7 te7f J(7 - /4c/dr h�� 55 S P LFo
<br /> M o,-(S.e . ..� '.N"+ IL i C / /it0 "�S (- f P_ `- ' C2/ / rs. /90(c,�7,y7 ''le �-.; ae� F_
<br /> c
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): 41l' o "(' e kt S/ 'r-t7 / /At 't..-i 7C� r c��,'(2
<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) 3 Shower,Tub,or Combo
<br /> Boiler Gas Range 4 Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> / Clothes Dryer / Heat Pump&Ductless Dishwasher Aff y Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) I Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> if 3 Exhaust Fans(Residential) Commercial Ventilation Floor Drain 3 Toilet
<br /> tt'� 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 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 /> / / 7 PERM y A., Z_ Ro'q ' Cl
<br /> r 16 2G
<br /> ner/Autho zed Agent Signature Date (Revised 10/10/2018)
<br /> � 1
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