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<br /> 1110al PE :', IT APPLICATIO110
<br /> BUILDING!MECHANICAL/ PLUMBING/SIGN/SPRINKLER! DEMOLITION
<br /> EVERETT CITY OF EVEREi i PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-25743810 I FAX 425-267-8857 I(E)everetteps@everettvia.gov I wwweverettwagovipermits
<br /> or Black It* PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS:2.1 5 ID o y.n Ave. EV e're- 4 La k 1 g2° PROPER1Y TAX#: 0 0 0 31,2-5 0000 1 4 00
<br /> LEGAL for new consbuction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> CONTACT INFORMATION
<br /> OWNER NAME: U tf ses S i evro, \I e Ck TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAIUNG ADDRESS: STREET 1, t 1 58 +IN AN e S E
<br /> . 5 r.,-0 0 PA,--5 STATE LA) „ 8 21(,
<br /> OWNER PHONE: 1.2.,5 3) 89,3- . '421 OWNER EMAIL: S i ei-rok.k-cArTtifillig avvvoCi I- co Ari
<br /> CONTRACTOR NAME: U tr.5 e-,5 Sre-cr cA. \I e...0„, "
<br /> CONTRACTOR ADDRESS: sneer 1,1 3-2.9 S 8 +1,,t. kkie„ S E ,
<br /> cn -5 It\o letoirALINk STATE LAI-A vP ci 8 z9,6
<br /> CONTRACTOR PHONE: (25.3 ) 8i3-514 Ft 1 CONTRACTOR EMAIL:Sc e-'(fa,. Eva.mi"ctD it
<br /> CONTRACTOR LICENSE*REWIRED): ICITY OF EVERETT BUSINESS UCENSE#(REQUIRED):
<br /> PRIMARY CONTACT: )(OWNER 0 CONTRACTOR Ci OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: (,2 5-3) 2 co- 998 1
<br /> 0 ti_Ses 5 i-e..-cf e.,,, Nil e-°,10,.. CONTACT EMAIL:5"c e-y-y.0,, -sr-C4,rel.?A•
<br /> . . .. ,
<br /> BUILDING INFORMATION
<br /> 'Existin• Use of Buildin•:
<br /> Proposed Use of Building: Heat Source: OGas E3Electic 00ther .
<br /> —
<br /> BUILDING USE: E3SFR EITownhouse Duplex DADU DIVIulli-Family-#Units: DCommercial DAccessory Structure
<br /> Type of Protect New DAddlion ORemodel ORepair OT.I. OSign DSprinkler ODemoltdon OChanpe Of Use
<br /> "DESCRIPTION OF WORK:
<br /> r--
<br /> Nei 0 co Ne..1- ?e,V flit(4- 4-4 Ceit N.5 A-c-Y-
<br /> ,
<br /> Pc,C, sa -
<br /> ., C.... 1,603 - COLIt ,.
<br /> ASSOCIATED BUILDING PERMIT# If-1,.icable
<br /> i MECHANICAL PERMIT APPLICATION i
<br /> i PLUMBING PERMIT APPUCATION
<br /> ,..
<br /> ' Fixture Mime , Fixture Fixture
<br /> List of Feat/Fes List of Fixtures List of Fixtures List of Fixtures
<br /> : count Count Count
<br /> NC-Air Handling Units I Gas Piping ' Backtlow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-camp,prep,floor)
<br /> Clothes Dryer , Heat Purrip&Ductless Dishwasher Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) ." Refrigeration Drinking Fountain Sink-Utifty,laundry,mop
<br /> Exhaust Fans(Residentiat Commercial Ventilatior< Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) i 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 /> , Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> SPRINKLER!SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other
<br /> ater Suppression System No.of Heads
<br /> nocalupplession System -1‘17.74 Heads
<br /> ACKNOWLEDGEMENT:I have remissed this appfication end confirm the kdormarion co'herein is true and correct.Work done pursuant to this permit must comply with
<br /> current federal stale,and kcal law.The granting ate permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Buffdrig Official before being authorized under any circumstance.lam the owner,or!am authorized by the owr?or of this property to perform the leor*for which application i s made,
<br /> and I comply with the State Contractors Law 18.27 RCW athtf 296.201JA WAC.
<br /> $ b Oily of Everett Official Use Only
<br /> figelf -.
<br /> ------2/1 fiZZ I I T ,
<br /> 0 rheuthorized Agent Signature te (Revised ffY 6)e-
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