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® IIII PERMIT APPLICATIO• <br /> II <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) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 5)11 SM,7 i ei„0 (.43AN/ PROPERTY TAX#: CXXS(e7:1A7300?D). <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Terr.j Tht.O44As TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET gin • $B1V)el*) WAN/ 'CITY Eyes STATE 1.�] w. ZIP 92243 <br /> OWNER PHONE: 'MS- 4120" S'Oto7 OWNER EMAIL: NIA V, I <br /> CONTRACTOR NAME: Co))1+ Extern r , . v1G.. <br /> CONTRACTOR ADDRESS: STREET 1 y(GJ$ AJ& /A) worri I&Ali i I 1.4., WAY <br /> CITY LOlTri `M V r i[E. STATE W A ZIP 98074 <br /> CONTRACTOR PHONE: 2.53 -wig -Sly l CONTRACTOR EMAIL: 4tvjy% C' camitexfrrtors .emm <br /> CONTRACTOR LICENSE#(REQUIRED) Got,iliA.irti,y§GL CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER xi CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253..gyy- 5-1 y j <br /> IeVII\ Cal 1A, (4 CONTACT EMAIL: geV,`N COb91.If-exit nn(`S,GnwN <br /> BUILDING INFORMATION 11 <br /> Existing Use of Building: 5PA Contract Price of Work: $ 1w. <br /> Proposed Use of Building: 5 F,4 Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ' SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ❑New 0Addition Remodel ❑Repair CIT.'. OSign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: J <br /> geki100 e st 2epWe ex.Its-1-1 >ec <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 /> 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.1 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 /> c - (a _ ,ct 310(6- o(b <br /> Owner/ horized Agent ignature Date (Revised 4/15/2019) ) ", <br /> 1 <br />