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MIN <br /> PERMIT APPLICATION. <br /> lari 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(E)everetteps@everettwa.gov I https://everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: -' (,(oar v gotot_ (A.AatA PROPERTY TAX#: dbgibri Zoe:` 4,04) <br /> LEGAL for new construction: Short Plat/subdivision CIA-f1Lt. Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L.5,-- '(,, f,, _ TENANT BUSINESS NAME(Commercial): vAct., YYl. p4Ce1 <br /> OWNER MAILING ADDRESS: STREET 500.1. 'S Sip <br /> CITY STATE (AA ZIP ¶� 3 <br /> OWNER PHONE: -- OWNER EMAIL: �--� <br /> CONTRACTOR NAME: 4,�,,,4►.t, Catrri4,Mck. <br /> CONTRACTOR ADDRESS: STREET b 1 b( Li.% <br /> CITY 19"Aik C.Pleak STATE `,04 ZIP VoV 2 <br /> CONTRACTOR PHONE: 20(o $ OS c - CONTRACTOR EMAIL: 'breve, Q h { �,�c 11•1ro. <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ,'OTHER(Please Specify) AaaAtetaet <br /> CONTACT NAME: ?AA_ 9.40u4,(1405, CONTACT PHONE: l,e '2'.t,1, Ok4,41.; <br /> CONTACT EMAIL: p e <br /> BUILDING INFORMATION <br /> Existing Use of Building: tykia#44eVT Contract Price of Work:$ T.i;D ;O O <br /> Proposed Use of Building: iewia.10171 Heat Source: ❑Gas DElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Vcommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel Nepair ❑T.I. ❑Sign ❑Sprinkler ElDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: Upve• �� vp "V <br /> ASSOCIATED BUILDING PERMIT#(if applicable): (NA_' l'<-- <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 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 Valves or Fixtures <br /> Forced Air Systems Other: Medical Gas Water Heater <br /> Gas Fireplace/Insert/Log Roof Drains <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 /> PERMIT# <br /> 01 tit tAi 2-00:-(0:1 <br /> Owne A thorized Age ' nature Date (Revised 10/10/2018) <br />