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NM <br /> • PERMIT APPLiCATIO• <br /> n BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> EV ECITY OF EVERETT PERMIT SERVICES <br /> Y 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetleps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SiTE INFORMATION <br /> PROJECT SITE ADDRESS: (.0(Q24'eve.4.06y.4mV I 0 PROPERTY TAX# 3 f 2r <br /> LEGAL for new construction: Short Platlsubdiviston Lot No.F (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: + )S P i)}14,6 --t tom, TENANT BUSINESS NAME(Commercial): 13.1S klaVYKiYfitte <br /> OWNER MAILING ADDRESS: STREET (fj10% eiveirG ep,4A— y>l Pt t �)AJA, 47 20 3 <br /> CITY el/ettaik STATE VVet . ZIP elk2d <br /> OWNER PHONE: ggc^^ t.oi- 2- OWNER EMAIL: 1/5kS ,cj-t le 3 zeit I� .�'?YL <br /> CONTRACTOR NAME: / 'J jJ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: --� <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): l T g S2— <br /> PRIMARY CONTACT: (OWNER El CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ) CONTACT PHONE: vl W .-. (� "a5i 2 <br /> '3116t-Pt. 00V� - (FY Vwa 1 t CONTACT EMAIL: /03 S G t tb jA( �Xyyeb,1, Cf>.)-L, <br /> BUILDING INFORMATION //��qq]]�� 1�� <br /> Existing Use of Building: + f4j, i,Q, A{,darn,&}-j IJ.G petite Contract Price of Work:$ 1�OV <br /> Proposed Use of Building: ►► Heat Source: ❑Gas ❑Electric ClOther <br /> BUILDING USE: EISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: 1, ommercial DAccessory Structure <br /> Type of Project: ❑New iS <br /> Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler !!!/❑Demolition OChange of Use <br /> DESCRIPTION,OF WOR I <br /> t Yl. 't t) GU t,d r9141,111 vi. )11/.0 t,lik- 1',C 0-F �''��I� <br /> L1 l.f/vt <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 Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heal/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/011 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 1 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,slate,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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ate rCCiityy�of Everett Officialial Use Only <br /> ( f /rd6. PER <br /> `' V� ' O ✓� <br /> 0 l torized A gnature Date {Revised 10/i0/2018) <br />