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= • PERMIT APPLICATIO <br /> LI <br /> BUILDING / MECHANICAL/ PLUMBING I SIGN*PRINKLER/ 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: ZD svJ Cv c('e N\ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description <br /> CONTACT INFORMATION F --- <br /> OWNER NAME: /V r;'\c�" tv �()0AN. L�.0 TENANT BUSINESS NAME(Commerc ��C(� .,, �� t <br /> t 1 <br /> OWNER MAILING ADDRESS: STREET Z.4 .0\ �J(Gk A c,,, t,U I', }�- 1 D 3, <br /> CITYSUVk3',r.r�\ LR STATE "�vN ZIP `1gZ_q ' <br /> L2S OWNER PHONE: , SS 1-1?-,`Z27 OWNER EMAIL KeS1e I® �len.t,,fi0 �,FFr � <br /> , t v <br /> CONTRACTOR NAME: \iVe k\,M Q y N e--4.1 n SI\ RV <br /> CONTRACTOR ADDRESS: STREET 7 2-1 (l,t-' t� tj <br /> CITY S 1'\Q A%L'V�\ l., STATE w'P% ZIP q 0le i <br /> CONTRACTOR PHONE: 4-j7-S SS3 L43 z$ CONTRACTOR EMAIL: I(y/3 t hair j coc `'Cr _ - v"'/ - <br /> CONTRACTOR LICENSE#(REQUIRED):( C-7-4 'A sS2 3' CITY OF EVERETT BUSINESS LICENSE#(REQUIR I): (0O4-1 O5M Ci b� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) SCI,c1t4 <br /> CONTACT`NAME: CONTACT PHONE: L�Z,.j L`32,t <br /> 14, 5I r y Sr,Gr«c-* CONTACT EMAIL: y_2Slf,A ,(Y,)-9r 1Af_, (..v,^ <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Wor :$ j 7/ q ci i <br /> Proposed Use of Building: Heat Source: ( Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 11t5S \l <br /> kA-e4 pump (r,sic, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Coun 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/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 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 /> I I H I <br /> 024 <br /> Owner/ tho ized ent Signature Date (Revised 4/15/2019) `� <br />