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EVERETT <br />WASHINATON <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL I PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />IP)42R-9A7.RRin I CAV non 1c1 Doll <br />- - —• 1 Tyr u•o,onep,Vnvareuwa.gov I Www.evereltwa.gov/permits <br />(Blue or Black InkDnly Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: '2G1i �/qjc �� �,�, PROPERTYTAX#:ram ti, ®Q <br />�p <br />LEGAL for new construction; Short Plat/subdivlslon at No._ (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: <br />)At <br />d"s. TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET <br />jl,�o <br />CITY 1IAO t4S(d �iV -- STATE �.,) ZIP <br />OWNER PHONE; <br />OWNEREMAIUKAP-of-I, 1.4 �n2 r- 6'mvafer Gcc+ "` <br />CONTRACTOR NAME: ip e4,mar•AS.. <br />CONTRACTOR ADDRESS: STREET W I'31 Cry^ <br />�[f <br />CITY M-e4aiF•( STATE V"" zIP <br />�,�,, pp <br />CONTRACTOR PHONE: �ts'tm° Gj ai(r� `�^�a� CONTRACTOR EMAIL; VI 1111/� LIC llt4 N CPvss^m <br />CONTRACTOR LICENSE #(REQUIRED); VkAf lell [a 61C WZ ` ICITY OF EVERETT BUSINESS LICENSE N(REQUIRED) ` 1,-V� m - <br />PRIMARY CONTACT: ❑ OWNER V CONTRACTOR ❑ OTHER (Please Specify) , I <br />CONT jCT NAME: / <br />I fa•^I j <br />CONTACT <br />CONTACT EMAIL: �pr�� pp ,�, <br />e <br />BUILDING INFORMATION <br />Existing Use of Building: ') <br />Contract Price of Work: $ rpm <br />Proposed Use of Building: 11-feat <br />Source: ❑Gas <br />Electric []Other <br />BUILDINGUSE: ❑SFR ❑Townhouse ❑Du lex ❑ADU Multi -Family -#Units: ❑Commercial ElAccessory Structure <br />Type of Project: ❑New, ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑S dnkler ❑Demolltlon ❑Change of Use <br />DESCRIPTION OF WORh<: _t <br />���� ('�-��lP('r�-a, �i7ui�. �!i^Ji-G�tL... A' �`�(�'f¢P�7s�• uar�� <br />(%- <br />ASSOCIATED BUILDING PERMIT # If applicable): <br />MECHANICALPERMITAPPLICATION <br />PLUMBING PERMIT APPLICATION <br />Fixture <br />count <br />Llst orFlxRres <br />Flxturo <br />puunf <br />Llst o/Fixtures <br />F/xture <br />Count <br />LlstorF/xtures <br />F(xtare <br />LlstofFlxtures <br />A/C -Air Handling Units <br />Boiler <br />Gas PIPing <br />BackBoW Prevenler (Inside Bldg) <br />Count <br />d <br />Shower, Tub, or Combo <br />Clothes Dryer <br />Gas Range <br />Heat Pump&Ductless <br />Clothes Washer <br />Dishwasher <br />Sink -Commercial (3-comp,prep,floor) <br />Duct System (Remodel) <br />Refrigeration <br />Dunking Fountain <br />Sink•ReMTd ntial (kfchen,bath,bar) <br />Sink -utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilalio <br />(Not H.WAC s stem <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type I <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />Exhaust Hood (Residential) <br />Water Heater <br />Wood Stove <br />Interceptor -Grease <br />Interceptor-Sand/OII <br />WasteM+ater Pipin Repair <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Service (behind meter) <br />Water Valves or Fialures <br />Gas Areplacelmsed" no I <br />Roof Drains <br />j <br />Water Healer <br />SPRINKLER / SUPPRESSION SYSTEM <br />ISSwage Elector or Sump Pump <br />Other: <br />Water Suppression System o. of Heads <br />Chemical Suppression System No, of Heads <br />ACKP40K EDCZ /cur. , I-.,- <br />- - ------•••�•. • • • ,,.,.o • o.,o,.ou ,,,,� eppucacuu gnu conurm me mrormanon contained heroin Is fwe 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 />euilding off/clef <br />before ling authorized under any circumstance. / am the owner, or I am authorized by the owner of this properly to perform the work for which eppticetlon fs made, <br />and I comply w!fh t ee Stle Fontmctors Law 18.27 ROW end 296.200A WAC. <br />City of Everett Official Use only <br />ry PERMIT# <br />Date (Revised 1011012018) <br />