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Nam PERMIT APPLICATION RIZ BUILDING / MECHANICAL / PLUMBING /SIGN /SPRINKLER/ DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION %jett j PROPERTY TAX#:00 L{ '41 0OOt,'4 00 PROJECT SITE ADDRESS:\b 2n , PG,,,�<_Q,._ \.\rtv,e, � ,"A. LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Z r b• Cg„r0`0w,_ \ J.jiA.0,v%. TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET \paja /..[. �u„r.k.e._ c.." Y . CITY G vAeN"P-tc- STATE‘....1.3 IS., ZIP Zu 3 OWNER PHONE:i2.5- aZ-3� -. "'"'130� OWNER EMAIL: C,�'w�.G�Md�.1cw„ n t1.c.A n u cc, CONTRACTOR NAME: \AD X,-, ( le,w..c..\,„rws„ ,t � CONTRACTOR ADDRESS: STREET 3 SQ 1 CZA.1.4.`c..b.- A,..rc. . . CITY L-r� Ne `� STATE A.. ZIP -Q L``b al) t CONTRACTOR PHONE: 4.2X" $$ci,_ .'2)1.?,3 CONTRACTOR EMAIL: G„1_` & bk n1L..WWas'�rtL4�Ov. ,CC)M. CONTRACTOR LICENSE#(REQUIRED):Iak_n x(Lx 9,C r tab CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 0 6 t ?V PRIMARY CONTACT: &OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4 oz. . _s g „ -7 30 s Co,pcNik.v.A...- a_s_00.- CONTACT EMAILc\vwe_ s.n N n ti c .40w t,..% tiotiv. BUILDING INFORMATION Existing Use of Building: S Tt.. Contract Price of Work:$ —70 t,(D0 0 Proposed Use of Building: STrtt- Heat Source: Vic as ❑Electric CI Other BUILDING USE: tRISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ONew .Addition Cl Remodel CI Repair ❑T.I. ❑Sign ❑Sprinkler CI Demolition ❑Change of Use DESCRIPTION OF WORK: & ` �� Z\NJ.\rtG.S _ S♦ 2.e_ Ok �G.c.� lag b JC- wv.- o WA- at9 0 v- \ ‘acsar‘.. 1 t-e-w►p k� bwA.+..; %n.0 v... o two s Uk- t?e. .-\ i ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C-Air Handling Units � Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems I Other: rt%p Medical Gas Water Valves or Fixtures 1 Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads. 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# �!�•. �.I 7/30//9 CI l 0 -' nil 03vner/Authorized Agent Signature Date (Revised 4/15/2019)