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M PERMIT APPLICA TIOK• <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I 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.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ( ' Cl >,y-1'' -. '- S W Cyc'rc_ Uv'H PROPERTY TAX#: j 1(-7O Z c.C <br /> LEGAL for new construction. Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: J__.Q.. krc, TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET '3\1 S A-‘---, S-C SL,3 \ ! <br /> CITY ����e STATE w c-. ZIP ell S"?..—CS)3 <br /> OWNER PHONE: LA7_S--3 L L - f•-t_ 3 S OWNER EMAIL: <br /> CONTRACTOR NAME: (,Je. (N Cr-c_R z,No-v-\ (....Lc___ - V r( _k (-c'e_< <br /> CONTRACTOR ADDRESS: STREET I L.1(7 F7 Z6_ i^ok Ave SC <br /> CITY i 'ten rpC__ STATE /A)C., ZIP L Q Z--7 Z <br /> CONTRACTOR PHONE: 2oG -SS�-C.,-21{-S CONTRACTOR EMAIL:(Jes ,cy.(� c....;-'sfr c r 1 i C..�cytJ(Y�0.r 1,&Dal <br /> CONTRACTOR LICENSE#(REQUIRED): tj 1 C E L L`'U� (-L .) N CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)3 <br /> PRIMARY CONTACT: ❑OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Zc�V- jSg •-c: 2yS <br /> r <br /> Lk �1(`(\e-S CONTACT EMAIL: S f-A Lc krev:-(\ (lc�• ,n,'k-=- ( ,C ry <br /> '� � (c_BUILDING INFORMATION <br /> Existing Use of Building: KC'-it�(G�1/S',(1\519 } ,tn 5 .5 Contract Price of Work:$ ��G� '�� <br /> c <br /> Proposed Use of Building: (i>\\ Heat Source: iGas ❑Electric ❑Other <br /> BUILDING USE: )KSFR ❑Townhouse 0 Duplex ❑ADU ❑Multi-Family-#Units: DCommercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition DRemodel , epair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ji`\ .iP l i r ,k`( I G c . I A �: t. F )4 , --L ,(45 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List 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 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-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/InserULog Roof Drains Water Heater <br /> SPRINKLER i SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> - <br /> Chemical Suppression System 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 /> City of Everett Official Use Only <br /> Z-i I I , z�/ PERMIT �O On D 1 b/ <br /> Owner/Auth ized Agent Signature ate (Revised 4/15/2019) <br />