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-- 0 PERMIT APPLICATIONO <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 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov ( www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: d 31 ce '37 t^ 5 i <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plattsubdivision 61 Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: G (LAtvD CO3-j00tAJJ101A3 TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET / / 37— 496 57 <br />CITY -�V���= J / STATE QNVA- Zip 7 n Fr20%---- <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: /0&nzor 6n &!. SE-awaS <br />CONTRACTOR ADDRESS: STREET 11010 Goa+7ti/, ,! -,Ita Njf <br />CITY br G STATE ZIP <br />CONTRACTOR PHONE: LIZ S'-IV7- 'j 7S� <br />CONTRACTOR EMAIL: AlicK ztic t;NaR G SERv<c'65. co <br />CONTRACTOR LICENSE #(REQUIRED): Y(Lt L< r <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER JZCONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />AJI LQ <br />CONTACT PHONE: <br />CONTACT EMAIL: �/, M ENe SE2Ve DES .�dM <br />BUILDING INFORMATION <br />Existing Use of Building: G0nr pv <br />Contract Price of Work: $ 2 w <br />Proposed Use of Building: <br />Heat Source: ZGas ❑Electric []Other <br />BUILDING USE: ❑SFR []Townhouse ❑Duplex ❑ADU ZMulti-Family - # Units:_go ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel VRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: /ZeI04A,L1 K 64s IZ6r,`-_ <br />-w pew <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C — Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen,bath,bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatio <br />(Not Heat/AC system) <br />Floor Drain <br />IToilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems I <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log I <br />I <br />oof Drains <br />Water Heater <br />SPRINKLER/ <br />SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />No. of Heads <br />ACKNOWLEDGEMENT., 1 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. 1 am the owner, or / am authorized by the owner of this property to perform the work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />-3-AG-1 <br />Date <br />City of Everett Official Use Only <br />PERMIT # A�^/ <br />V✓ ,3 - <br />(Revised 10110,12018) <br />12- <br />