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0 • <br /> - - ------ -- ------------E V E R E T T 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:✓L l n Z (PO ' Sk �1..,{x et e lAAa 1 kLo3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: l 2.V� Cy i' c )(1 S TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTIxeer 2(0 Z (0011'1 Sk S E, !� <br /> cm Vert A- STATE 1,�.L� ZIP b(/ <br /> Z <br /> LI <br /> OWNER PHONE: Z5--3t11 -33�---A— OWNER EMAIL: t'C;SS -- LA 0 if-vo' j,yi i L ' E.pl-vk <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): <br /> PRIMARY CONTACT: IfirOWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: i-19_5--.3 I�) - 3S T + <br /> Ste V s 4°. C 9 VJ t 1\-Q.S CONTACT EMAIL: r0SS c`~C� k erk lrl \ck,1 l-. l rv, <br /> BUILDING INFORMATION Existing Use of Building: vest 04✓\c:r- Si— Contract Price of Work:$ 4 cc CD <br /> Proposed Use of Building: S(—airl--- Heat Source: ❑Gas ®E`Iectric ❑Other <br /> — <br /> BUILDING USE: LFR ❑Townhouse ElDuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel Mepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: t r rGq C-i 1`t C dc Y Y ner— ili.i L I f C�r` t <br /> � � "� rc,l-tt- �l }� " <br /> ( � s ca 11 rYt5 v¢f -the h uv'Sc. <br /> v\i att, v j7w( AM) -cam d.,,ef Irlst;Sc .rtl (A WIWI _11 fr;fi Skp IM h-A 4.- �---k-• <br /> ASSOCIATED BUILDING PERIBT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fay Fixture Fixture <br /> Count list of Fixtures CountList of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration 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(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other. Medical Gas Water Valves or Fixtures <br /> rae 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 0 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.lam the owner,or lam 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 />