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MIN • PERMIT APPLICATION• <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLE / 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: `tk- - SL c oAlzge mil_ LAA A .9 PROPERTY TAX#: 0 cAvbD 2 o LC b0G Coo <br /> LEGAL for new construction: Short Filat/subdivision CIA-RLL. Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: („:31— Q(, 'j ( %. TENANT BUSINESS NAME(Commercial): VAGattc, YYAAp4CER <br /> OWNER MAILING ADDRESS: STRE.Er YJbc S SteAtAdkS toeyWk L�p,,�•.� <br /> CITY STATE '► ZIP t o3 <br /> OWNER PHONE: -- OWNER EMAIL: --- <br /> CONTRACTOR NAME: A4'6.w44, zciC5 .opt, <br /> CONTRACTOR ADDRESS: STREET 'bog, `5C7 l{% <br /> CITY v.A6A. «r- STATE (.44 LIP cOic,i <br /> CONTRACTOR PHONE: 2o(o T1,97 03 Qt- CONTRACTOR EMAIL: ,ates.rc P h),,,t{,j2 ‘, <br /> CONTRACTOR LICENSE#(REQUIRED): AlA 7-u 1,0,t,„-0,j(v U CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR OTHER(Please Specify)� p y) <br /> CONTACT NAME: (?ACAN,6404)S ALA. CONTACT PHONE: zeta-. '��t,(� ("vita <br /> CONTACT EMAIL: ,� _ U.C.. C V t <br /> BUILDING INFORMATION <br /> Existing Use of Building: tweViektt Contract Price of Work: $ `t-1; 1,OW <br /> Proposed Use of Building: VKAA AGIC'1 Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: USER ❑Townhouse ❑Duplex ❑ADU ❑Multi Family-#Units: l*commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel Nepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: c__p-e N4t,41 v vv-e. ,�t,•ty <br /> ww,ark /1/4/ o"` (C--) t`t C uC't <br /> ASSOCIATED BUILDING PERMIT#(if applicable): c .1 <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. lam the owner,or lam 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 alp td WO 1- <br /> Owne A thorized Age nature Date (Revised 10/10/2018) <br /> l 1 <br />