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• PERMIT APPLICATION' <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / 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) PROJECTI SITE INFORMATION <br /> PROJECT SITE ADDRESS: _S 33.2 Cc,��� Y�;c_. Evt(t PROPERTY TAX#:C^O`f3(097�OVI700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C_-C_I>&, (Z4D 1-y S4 LLkrd-• TENANT BUSINESS NAME(Commercial): S& .1.,, <br /> OWNER MAILING ADDRESS: STREET g 2 3) Co lb j At CITY vL i Q..TA D STATE A ZIP I Q <br /> b 2 c <br /> OWNER PHONE: t(a S' S�/' 17 OWNER EMAIL: C.t_IUr,4"N }j�p•�iS C.I�vf[� L �'ri�t�-r••Gem <br /> CONTRACTOR NAME: Clce S�c-; C _1-tcs:�-` J <br /> CONTRACTOR ADDRESS: STREET 7 SO`i Gra..��1 Sk• (�)•_cm, ��1'��:,CY�C� STATE a('9 l(} <br /> � zip O�1 <br /> CONTRACTOR PHONE: j S3" SSa- w) y CONTRACTOR EMAIL: 1044 L <br /> CONTRACTOR LICENSE#(REQUIRED): f i$i', S fl\k CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O (g. j <br /> PRIMARY CONTACT: ❑OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 0(0- <br /> k CONTACT EMAIL: bc14.3C �f u�S , t✓��� Coon <br /> BUILDING INFORMATION <br /> Existing Use of Building: Clr„�CC-L _Contract Price of Work:$ <br /> Proposed Use of Building: S4L✓r.,e.- Heat Source: Gas DElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse Duplex ❑ADU ❑Multi-Family-#Units: XCommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel 154Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: c-OOc.Ce.... "`r,+‘arse4114 Fv,gcpc.,C.t_$ in C1�c cc� Lscoszovr cf �.� Ur •I" <br /> 6" \-tu.c l c.re- I.`L., i n �c�� e kGL`i‘ c-eL 30 (A. eav- S Qix-T <br /> s eic►s ��-� yrs � p�r� <br /> t .t•naG¢S L.Gk 4,s onQ <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 /> a 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.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 /> Za.e./aA /4// 9 PERMIT# <br /> OwnerlAuth zed Agent Signature Date (Revised 10/10/2018) <br />