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- 0 PERMITAPPLICATIOIS <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 I www.everettwa.gov/permits <br />(Blue or Black Ink Only Pleased PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: d 3 r jr 3-7'^ sr <br />PROPERTY TAX #•— <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: G(?A"D CO3j00 tAJ1%J'A5 TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET / 3 / 37^' AV6 S 1 <br />_ <br />CITY 6l&t / r STATE W.*- - zip 7 raq <br />OWNER PHONE: 1/2S-)b7-575'j <br />OWNER EMAIL: <br />CONTRACTOR NAME: sc-avlas <br />CONTRACTOR ADDRESS: STREET f /Or U CiOv+r)w, J 1,efta 616 <br />CITY STATE ZIP <br />CONTRACTOR PHONE: L/Z S'35r7- j 7S,1 <br />1CONTRACTOR EMAIL: Alit C M Zt)C EnrERG Sa<Rv<ces• Cu <br />CONTRACTOR LICENSE #(REQUIRED): -rrZtr r <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER OCONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />A/(CtC M C I A'j&t <br />CONTACT PHONE: <br />CONTACT EMAIL: Abut Q—M EN'e 5 E2V, e-a ACPel <br />BUILDING INFORMATION <br />Existing Use of Building: E 0ry pv <br />ract Price of Work: $ '1 Cont�v a <br />Proposed Use of Building: <br />Heat Source: ZGas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU 0Multi-FamiIy-#Units:_yq ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel PRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: R,./!�oCjf <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 Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <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 />lOther: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/inserULog I <br />IRoof <br />Drains <br />Water Heater <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />I No. of Heads <br />Chemical Suppression System <br />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 l 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 />-3-AC-1 8 <br />uate <br />City of Everett Official Use Only <br />PERMIT # <br />A4 (TO Olt S <br />(Revised 1011012018) <br />(/Z <br />