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I• • PERMIT APPLICATIO <br /> BUILDING / MECHANICAL 1 PLUMBING /SIGN I PRINKLER/ 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: /Da r /3 zfl ST PROPERTY TAX#: rT 49SI v00;o,P-7 o <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ?Ole-. I .0 __C VE -*- TENANT BUSINESS NAME(Commercial): _T r( abf 4_,,J,A Q fq <br /> OWNER MAILING ADDRESS: STREET ?&ily: .53,_ - <br /> / <br /> CITY ( G. ' STATE la ZIP G c�V1 <br /> OWNER PHONE: 4I S_3Fr6-°c i - OWNER EMAIL: <br /> --CONTRACTOR NAME: - Pyl es-Yse_ Et j_. a`- 4.JC <br /> CONTRACTOR ADDRESS: STREET 4D-6OS" ((ay. 7 --V. <br /> CITY KNOT- Ve,P,yvp1 STATE LJ4 ZIP 7/8a'7�' <br /> CONTRACTOR PHONE:11Cp,Y.w. /3as CONTRACTOR EMAIL: ?Fe/pi/TS fl WleVe/2 S(67-3,co,-, <br /> CONTRACTOR LICENSE#(REQUIRED): /)lE`2, Te $30,38 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):' 7 b)0 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME\ CONTACT PHONE: .5�6'e,YaY /3c'S <br /> C Z -6U G4 4.r CONTACT EMAIL: N.. M its fl Mgr r 6,„ ,cow <br /> BUILDING INFORMATION <br /> �� to- <br /> Existing Use of Building: `('- C'9�AviP.Q.,7- Contract Price of Work:$ Or 9c 9 <br /> Proposed Use of Building: /mac ,fie A ,P,,q,r Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Wommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ETA. liS<gn ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: p /� <br /> .- f +,riNt.c `7_ , '�wre4 At-cc'( t L.L vi11,"."4T l C-3-TMe- Sc, S r-d.0 X r7Y 4a au, <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.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> /1 /2018 <br /> Owner/Authorized Agent Signature Date (Revised 10 0 ) II <br />