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• PERMIT APPLICATION. <br /> a 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: .� ( C G 117`< A�(' - E_)'J j� 11 y j,`. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> •OWNER NAME: Z h/ X I O r'0, � f IA TENANT BUSINESS NAME(Commercial):/� FYyiyl IOni n -rich <br /> OWNER MAILING ADDRESS: STREET f 4O'f' (q75�• PG- �' /�'i �G141- <br /> CITY STATE /' (1 ZIP /�I U 6/Z <br /> OWNER PHONE: 'jZ 5 - a V 5 - G 6 4 8 .OWNER EMAIL: IX I 0 Nlr (a CO 6 U (f/CY[OD • cOWl <br /> - -• .— r 1 _ - <br /> CONTRACTOR NAME: ,� - ! <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> i i <br /> CONTRACTOR PHONE: `` _'_ ``_ - 'CONTRACTOR EMAIL: _ -- <br /> CONTRACTOR I <br /> LICENSE#(REOUIRED)3.!'w �g�,,/�� �� CITY OF EVERETT BUSINESS LICENSE#(REQ 'R/ED):�/ (o <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR Id,OTHER(Please Specify) �J r ` /jk %1( ► C v/ <br /> CONTACT NAME: / , CONTACT PHONE: 2 ? - 3 3Z 3 <br /> NOS l 1 aVt n (Gd+O, ems'9Yls lltQG to) CONTACT EMAIL: il05 c -t ch.c#121 e(.). C ciin <br /> BUILDING INFORMATION <br /> Existing Use of Building: B 4 vih !(Miss Contract Price of Work:$ 0 7 rc) u <br /> Proposed Use of Building: A 2- k-e k t..1 Heat Source: Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: +5 ,ems+`,/Q s' rs-J..-4l,I'a(/I/�' )ii1.434 1 <br /> roue t wl pJ�b�`P. v'�`'� 1 's`�"�y <br /> (,....�wdJ4_`' 4 <br /> ASSOCIATED BUILDING PERMIT#(if ap�lic ple): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION ------ <br /> Fixture Fixture Fixture Fixture <br /> List of Fixtures List of Fixtures List of Fixtures Lisj,ef Fixtures <br /> Count Count Count Count . ,,,-- <br /> A/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower;Tub,or Combo <br /> Boiler Gas Range , -'' Clothes Washer 15.,ink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pip&5uctless / Dishwasher i2,,, Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain �` Sink-Utility,laundry.mop <br /> Exhaust Fans(Residential) 'Commercial Ventilation _ Floor Drain �� Z Toilet <br /> /2.,Exhaust Hood(Type I) -" (Not Heat/AC system) Hose Bibb , Urinal <br /> Exhaust Hood(Type II) Water Heater j Interceptor-Grease 1 WasteNVater Piping Repair <br /> Exhaust Hood(Rescje�tial) Wood Stove Interceptto and/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplape/Insert/Log Drains Water Heater <br /> SPRItER/SUPPRESSION SYSTEM 7' 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 L 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 2� � R ITkc <br /> 2 �,3 <br /> Ow r/Autho ' nt Signature Date (Revised 10/10/2018) <br /> y <br />