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0 PERMIT APPLICATIO& <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 Please)_ PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: y 31 ir '37 rA S i <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: C,(ZA,vO Co,j00 rrJi-J14S TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET / / r� 51 <br />L.37— <br />n <br />CITY 15vt-A /_rW .r STATE A- zip 7Fr2o1 <br />OWNER PHONE: 1-114 3b�`3�s�5 <br />OWNER EMAIL: — <br />CONTRACTOR NAME: A-n2r1C 6,v&!s Se-oviats <br />CONTRACTOR ADDRESS: STREET 11010 Goo v, ,,0 v:12 A/E <br />CITY 6-/fi STATE ZIP 9ac' <br />CONTRACTOR PHONE: fd2 S'-IV7- <br />1CONTRACTOR EMAIL: NrcK sttx 6rv4u SEI+y<ces• co <br />CONTRACTOR LICENSE #(REQUIRED): MA-rr4jCS 314Mr <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER UCONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Ail CQ M c (9A J&t <br />PHONE: L/ZS_ _ 5755 <br />LCONTACT <br />CT EMAIL: A/,,kp M E,,'eIlr=S ttV, LF.S jC rl <br />BUILDING INFORMATION <br />Existing Use of Building: C-SIV00 <br />Contract Price of Work: $ 2-v w <br />Proposed Use of Building: <br />Heat Source: OGas ❑Electric []Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ZMulti-FarniIy-#Units:_9q ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel Aepair ❑T.I. ❑Sign []Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: jL�PL/aC+� Qo / 12c0Gv�h/7f <br />4JO r ( 0 <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 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 <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/]nsert/Log <br />I <br />oof Drains <br />Water Heater <br />SPRINKLER / :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., 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 />-3-AC-/ <br />Date <br />City of Everett Official Use Only <br />PERMIT # <br />(Revised 1011012018) <br />