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v <br /> wiis <br /> • PERMIT APPLICATION <br /> liz <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> W A S H I N G T O N (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: '/// G3 (AsiNO /<C'=?D PROPERTY TAX#: c3;e)9A,7od,3 c 3OO <br /> LEGAL for new construction: Short Plat/subdivision .__ .._ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C /)A2 Te-1 C`Z),1.1m RA 1iit_!/7/E S/� TENANT BUSINESS NAME(Commercial): 7?l R/1 /1// S' <br /> OWNER MAILING ADDRESS: STREET 7 ii 1 (d\J ti /,C l..T 5CE-C/-/ SST .S.L)/7 ,3G)v ,! <br /> CITY (5A/l.) 01 L- C ( STATE f) ZIP C/,l7 <br /> /O/ <br /> OWNER PHONE: (JAI - V 0 ,O d OWNER EMAIL: k-i r z /(•Z C C l r i c h . (or-) <br /> CONTRACTOR NAME: /1? Cit-'/-)>91ARI) /4J/)LJS772/C`' %/\/'eeg/26wA7-E/) cow /1'7CA-I4/niik/•l ,51e',tfis <br /> CONTRACTOR ADDRESS: STREET /VC;,e3 t4/ 1 E C/T-' CUJ,4 j' A/C,' J <br /> CITY SC/9 7 � STATE (lJ/41 ZIP q8/2 5- <br /> CONTRACTOR PHONE:(246') ,2 v- ogee/ CONTRACTOR EMAIL: hea'her �mer'1ar-iara Si'94J• e <br /> CONTRACTOR LICENSE#(REQUIRED): Ale AJ" L- *031 Olt CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5/7 L)5.0 <br /> PRIMARY CONTACT: ❑OWNER I -CONTh, :OR 0 OTHER(Please Specify) <br /> CONTACT NAME: 'CONTACT PHONE: ( 'o ) aP/j/_ &o J <br /> /hme- /276 NA-2✓73/--7✓;'r4 (CONTACT EMAIL: � <br /> /I,,,ke- C "J /NC/)C irk;hi Si 9/-)J. <br /> • e Dr 1---) <br /> BUILDING INFORMATION <br /> Existing Use of Building: /)'1 y z 77 Ffi/y7//-t. Contract Price of Work:$ / 3, 2 L'L) <br /> Proposed Use of Building: !1'i L/t 77 I//r1/ - Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex L JADU Q9rMulti-Family-#Units:J 3? ❑Commercial LAccessory Structure <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.I. Sign Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: RE Pt M c/ /6 TLv U -lv;7 71- S/fs,c..(�S 14-` %77/ Ail J A) <br /> A 0kJ Ft-F e Re i C A1(, Uu[J 6 S^/0077, /&) t.- X / ST7/t"rL- <br /> /7c-/1,u-77 MvG A t_--)q - L/ c N 5/6- Ai is y 'x , $vim Fi4 LC _ <br /> ,ASSOCIATED BUILDING PERMIT#(if applicable): /1•-)CU C/ Ai 1 <br /> MECHANICAL PERMIT APP:.'CATiv::' I 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 Pui,o&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior 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 /> 1 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 /> Chem:-.:al Sur.p ession System t IIvo.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._'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 Contrack'rs Law 18.27 RCW and 2911.200A WAC. <br /> City of Everett Official Use Only <br /> c/ d G/ 9/S �.6� 6 PERM'`� .)� 2xc1 — n0 CO <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />