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• <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-88grr10 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: 55©/ st,04 16' t PROPERTY TAX#: t 9760ZO2DDD <br /> LEGAL for new construction: Short Plat/subdivisionNIA, 4A c p[.2Lot No. ZO (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ne//RAJ-61- ' /QO/*52.7/,NE-< G/'C TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET/77/355A LpS. ' c7 - S•U//e /,/�2v G �] <br /> CITY `l)/-1 t 'v D STATE (�(J/7 ZIP 7 D.S <br /> OWNER PHONE: 42�- 993- ,$j 97 ,/ OWNER EMAIL: <br /> CONTRACTOR NAME: /1/(42k ,"/ g/ 4 4// ' aC j ZIC <br /> CONTRACTOR ADDRESS: STREET/4�'a3 3 (j/fU�Z�GLS/V Al, /W. 9 fin/ /� c <br /> CITY At /t /O/1 STATE /04 ZIP 70$ 7 <br /> CONTRACTOR PHONE: 425- 414"-6y36 CONTRACTOR EMAIL:Mn 6 Pt%Gj/7j?//# cO1i/'1 <br /> CONTRACTOR LICENSE#(REQUIRED):/%48/ 1/1/CB$B/'I2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 1316THER(Please Specify) bk:S/G,tJ .- _/ : 2 IU.L <br /> CONTACT NAME: CONTACT PHONE: Z0 -6/2- S SW <br /> Am,L bit1A1 Go776/44:29 A134 PlAti 0i0S <br /> 5/2S 97 Aix s s-/77T2, /8//g CONTACT EMAIL: yi/i 'O7/79/eSk/C1 h/)07)&1, ,6/2 <br /> S' / `'BUILDING INFORMATION <br /> // <br /> Existing Use of Building: /2 Contract Price of Work:$ 5/d00 <br /> Proposed Use of Bui ing: �/ / Heat Source: 13Gas ❑Electric ❑Other <br /> BUILDING USE: FR ❑Townhouse ❑Duplex U ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New L ddition Q1lemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ///e/14O0/2"L ,&-X/t7/416 27ly/ . cSf7 ' ' AD,?? ,'U'/(J fir-2�/ 7- <br /> /Q?QChf-/440 /7 A 00/7/04) 7'0 6-/51e, of- .e& GC4-/E Sc0// /rT/' Y- <br /> /UO/!i-.8/492//c/6 /fLJ7/r2/02 1 /C S <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 /> 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:1 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 federa tate,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 Off ial before being authorized under any circumstance.1 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 co ly with a e ontractors 8.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMI A N4 /Cn <br /> D <br /> V Iy <br /> O ne IA th6rized ge t Signature Dat (Revised 10/10/2018) SS <br /> 1 <br />