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0 • <br /> 1111M PERMIT APPLICATION <br /> 1112 <br /> BUILDING/ MECHANICAL I PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> EVERETT 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.evereftagovipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 149 35 SeeKvi etAi k.A.30,k), Elle reit) \kJ IN PROPERTY TAX#: 00S619 00 4 00 203 <br /> LEGAL for new construction: Short Plat/subdiviston_ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 3 4-e ve,„ ClC r r,rf‘ TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET i 93 s SROwi g14.1 AMA.1.5 <br /> CITY v e re fi- STATE p., ZIP S,103 <br /> OWNER PHONE: 925 - 2,C.8- Sct 07 OWNER EMAIL: <br /> CONTRACTOR NAME: \AI e si-e f v-) Sa 10.., L.n c . <br /> CONTRACTOR ADDRESS: STREET L 04 1 Fjorrw 9,Li, sAit,,1.4t pN. <br /> CITY 5*-t 11 iAttl i"\ r'• STATE VstA. ZIP 18 2,2 c, <br /> CONTRACTOR PHONE: AG,0 - 1 Li(p- 0 a S9 CONTRACTOR EMAIL: I 0,A-Ta p UJ al..ef r.,9,6 lox:At. tory\ <br /> CONTRACTOR LICENSE#(REQUIRED): NESIES4f. cl 103-0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):054 j 55 <br /> — <br /> PRIMARY CONTACT: DOWNER " CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 5G0 - 14G- OSTi <br /> C.he geO.,4 ig, CONTACT EMAIL: <br /> ''',I tw we Vreco Se kp.r i n C• CO roN <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 0 S 0 <br /> Proposed Use of Building: Heat Source: 0Gas ci Electric 00ther , -...--- <br /> BUILDING USE: SFR [T]Townhouse .711Duplex EADU uMulti-Farnily-#Units: EComMercial DAccessory Structure <br /> Type of Project: ONew EAddItiOn DRemodel ORepait DTI ESign iliSprinkler DOemolition r_lChange of Use <br /> DESCRIPTION OF WORK: i <br /> ONS044.11 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixtutv Fixture Fixture List of Fixtures <br /> List of Fixtures List of Fixtures List of Fixtures <br /> Count count Count Count <br /> A/C-Air Handling Units Gas Piping Backtlow Preventer(Inside Bldg) Shower.Tub,or Combo <br /> Goiter 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 Ventilatior 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-SandiOil 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 I SUPPRESSION SYSTEM Sewage Elector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System _ No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is Ina and correct,Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit on/y authorizes approved work arid no deviations meter-cm,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 authonzed by the owner of this property to perform the work for which application is made. <br /> and I comply with the Stele Contractors Law 18.27 ROW and 296.200A WAG, <br /> City of Everett Official Use Only <br /> , PE <br /> Owner/Authorized Agent Signature Date (Revised 10/1012018) <br />