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MIN PERMIT APPLICATIO <br /> BUILDIN . ECHANICAL I PLUMBING /SIGN RINKLER/ 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: (C 'i-'CQC-/f i t ‘1, 2-�TT w V PROPERTY TAX#:C t`A ct()1(,2 A() i-1 CS <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: I\`D vitrY,k S%1L CA" TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET nZ.� 3.3"\ 5 (Q--et <br /> CITY EsaI• STATE ZIP 1 ta 2C 1 <br /> OWNER PHONE: el 2._5 41{ y�' � OWNER EMAIL: N1•-•Skit)�1 CJ�� k{ o•c.i-`11,"1 <br /> CONTRACTOR NAME: \5 LOnS AC CY1 Cc " \ c.,or ci ar) <br /> CONTRACTOR ADDRESS: STREET \ D\\ a ejrk 5'r <br /> CITY l !`1`� C �V CVO', STATE L 0.- ZIP 9 `z`5 b <br /> CONTRACTOR PHONE: 423 sc\c) Cj(. (C 4 CONTRACTOR EMAIL:C ( ,c� ; ,\5"Coils)i—u-0-'Lv 1, (c.,:.•+.s <br /> CONTRACTOR LICENSE#(REQUIRED):VE:C A\LA A / CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5q`lj e <br /> PRIMARY CONTACT: 0 OWNER ;51 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:1 a 1 CONTACT PHONE: 426 9C( C, c <br /> CALqq L'1 CONTACT EMAIL: (::_(CC('-) ,ld L AVS — V(1N�;�0YN. . N <br /> BUILDING INFORMATION <br /> ExistingUse of Building: ' 1Contract Price of Work:$ `" ‘(.U' QCO <br /> ���n'�� -�wY� \� (eSrL�S2,n� <br /> 0 <br /> Proposed Use of Building: '` Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: L�.SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel VRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> feockkr AYG•m',0,..) a\A',tle' u.)11(1A,�sw , Q. \(� kr. CIcao" et \...15 e(G,vl'1C.tCr_A <br /> J h V�.1�. �. -JL 1 vtn ec + ' (� <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) Shower,Tub,or Comb <br /> Boiler Gas Ran.,-'- Clothes Washer Sink-Comm ' 3-comp,prep,floor) <br /> Clothes Dryer Heat ''imp&Ductless Dishwasher Si sidential(kitchen,bath,bar) <br /> Duct System(Remodel) 7 rigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) ,- Commercial Ventilation 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(Resid: 'ial) Wood Stove Interceptor-S-e e"Oil Water Service(behind meter) <br /> Forced Air Syste, " Other: Medical,-a Water Valves or Fixtures <br /> Gas Fireplac-y'sert/Log Roo.drains Water Heater <br /> SPRINK R l SUPPRESSION SYSTEM sewage Ejector or Sump Pump Other: <br /> Water Suppressi., System No.of Heads <br /> Chemical Sup,ession System I INo.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 /> T ) 6y1 <br /> �- I( `Z� \� PENT(c:::Akc. <br /> ' <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) <br /> 1Z <br />