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• PERMIT APPLICATIOF" <br /> BUILDING / MECHANICAL I PLUMBING / SIGN PISPRINKLER 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: 1 IS rd Si-. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:'.1k r. - . 1' (. (�A 1 I rkke. at TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET '1(2, 53 rcl '+- <br /> CITY �Ci,.6 � STATE v/" ZIP 1 <br /> OWNER PHONE: 0 - -'-H I d OWNER EMAIL: J 1 (G+reLilo @ kb"I" u cc , I ' C-0vLfj <br /> CONTRACTOR NAME: 1-019 Ltki LA CaYv CiL ci-inI <br /> CONTRACTOR ADDRESS: STREET ) Q( 1+-45 ` �( <br /> CITY )1n0h tAII y� STATE �LJ/!-ic ZIP 'g2�y L I <br /> CONTRACTOR PHONE: _1l Z—' ?%S CONTRACTOR EMAIL: ,./(-�j..j,uR,C4'', Cam,('Cc1J i YlL4- <br /> CONTRACTOR LICENSE#(REQUIRED) PL__6.L e_,9 IDS B a. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 1412_ I7 <br /> 0 <br /> PRIMARY CONTACT: 0 OWNER l(CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L.-(25- 77Z, -5i E' <br /> J V 3k ek-fi..ety CONTACT EMAIL: ADShtt C .I ' , eta <br /> 'BUILDING INFORMATION <br /> Existing Use of Building: cA-jiii rev,.,„:, (i 1-1'j5 Contract Price of Work:$ (tfC 2.0CC) <br /> Proposed Use of Building: Xii/h _ Heat Source: Gas ❑Electric ❑Other <br /> BUILDING USE: [,XSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition XRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION�I� OF WORK: <br /> I mitz\lQ, of-- ylf -f.v�M 1 �o�S- ruc,-1�( f R( : : 2K4 <br /> ) <br /> - 6A. 5 -e-� T -k- Aid i hSvL 0sy--io J,0-4/116r-vj i,`- 0.-titOW 0 V‘'I <br /> ASSOCIATED BUILDING PERMIT#(if applicable): U.ARdoto <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 /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler I Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless ( Dishwasher 2_ 1 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 /> 1 Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> I Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump 1 Other: vp p,(^(th / <br /> Water Suppression System No.of Heads 1,0&74" <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� PERMi2cO.\— l Jl J3 <br /> Owner/Autho9L/t <br /> nature I Date (Revised4//15/2019) <br />