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411 PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> "IIPL.44/4C----4 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (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: (pci S'_ Cc-f S.oe, Vck PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Marq SIP Gu i I kin g.0 r‘. TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET tog'Q. ecw-Stlr RGQ <br /> CITY (:�1 ejt - STATE LA-A ZIP <D1, al L cS <br /> OWNER PHONE: /2 - 3c5 -ca10 OWNER EMAIL: <br /> CONTRACTOR NAME: ©Wk.J� I�� <br /> CONTRACTOR ADDRESS: STREET V <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR BOTHER(Please Specify) Ter•Cts\,4 — Div .e-(— <br /> CONTACT �'`4\ CGr°r-use,. ,-„A. , CONTACT PHONE: 1.fi _ 2 - _ -O g. <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$�iC10 <br /> C) <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:\20-Ce. <br /> p 1-?A'' <br /> - , 2 - <br /> ASSOCIATED BUILDING PERMIT#(if applicable): t,/) (g(�--®o _ fit-- <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 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 Ventilation 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.l 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 /> - Li'1, -co l. <br /> Owner/Authorized Agent Signature Date (Revised 10/10/20)8) <br />