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NM PERMIT APPLICATION In BUILDING OECHANICAL I PLUMBING /SIGN IINKLER/ 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 PROJECT SITE ADDRESS: (W(90 VT' NO I s,;J PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: G l -..j (_-_:,c' [ Lf1=-,tic '-1--'r- TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET $2r ) L,- �� ,0 ---._L'CITY E- c-_E.-c-T- 1 STATE ZIPC l p i t / OWNER PHONE: 4.'LC, c- ' 7 f, . i ? OWNER EMAIL C1fj r/F7 J,€� G' C'—`T- t;- +C3 "/ CONTRACTOR NAME: CA-A-)Nj }= g__ CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: A OWNER /0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 42_4S . 714 -4-' / ' 7 j O� .-- '\j-7 --. CONTACT EMAIL: l�l�+� /u,,,>:r./ FAA, f �l'T- i..-JUG .,(i3O-, BUILDING INFORMATION Existing Use of Building: f- (12-a S' 'nr J Contract Price of Work:$ A?' - ,' C:t-�(.) Proposed Use of Building: c______- Heat Source: OGas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ,Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel epair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: gx4=-A/4. - Z 'v'S Elf'-c_- � `"c its. �7r ,t t:p.�j - ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL,PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fix`---- I ores Count List of Fixtures Count List of Fixtures Co A/C-Air Handling Units Gas Piping FIRE /\-fin Boiler Gas Range DEPARTMENT r EVEREn. mp,prep,floor) Clothes Dryer Heat Pump&Ductless v\�tI ,n,bath,bar) Duct System(Remodel) Refrigeration 'P Exhaust Fans(Residential) Commercial Ventilation Office:(425)257-8113 Dave Hensen Exhaust Hood(Type I) (Not Heat/AC system) Cell:(425)754-4317 Exhaust Hood(Type II) Water Heater Maintenance Mechanic Fax:(425)257-8139 pair Exhaust Hood(Residential) Wood Stove dhensen@everettwa.gov peter) Forced Air Systems Other: s Gas Fireplace/Insert/Log CITY OF EVERETT•2811 Oakes Avenue•Everett,WA 98201 SPRINKLER I SUPPRESSION SYSTEM www.EverettFire.org Water Suppression System No.of Heads I 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I compl ith the State Contractors Law 18.27 RCW and 296.200A WAC. 1 City of Everett Official Use Only ly 2 �(J Z-L PERD(IT#�DOzJ 6*--. Owner/Authorized Agent Signature Date (Revisec�d/j4//115/2019)