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iiiim PERMIT APPLICATIO
<br /> im
<br /> BUILDINOECHANICAL / PLUMBING / SIGNIMPRINKLER/ 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: 3c03 U -s-- Cv.siAv R(.9•4tl 0' b4,t,1..[PROPERTY TAX#: 2isO-IjO(O0( () ZOo
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 80e.,i;7,a 6om x ny TENANT BUSINESS NAME(Commercial): Bo61 ,,i, gIG1�ci. `9O'3r)
<br /> OWNER MAILING ADDRESS: STREET //60 BOA 3-10 ] mS 6A l -0) J
<br /> cm, 5r tc� STATE 11- , ZIP v`z`j
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: U I k;,n j )its,.{�p,�,, ,C , 51/.n k.k C•�6
<br /> CONTRACTOR ADDRESS: —J STREET 3 y 3 Li I•'a' A,c, t CITY Jc-: "/C KJ
<br /> , STATE / ZIP 1 1S 1
<br /> zc } Z2 `'1G CONTRACTOR PHONE: 6 6 -- 5‘, CONTRACTOR EMAIL: (icnu.lJ. kovv.1 •J,\,. gpr,n(e.(•-e,Y,he,i;e
<br /> CONTRACTOR LICENSE#(REQUIRED): v i -I IQ Pi 3.73 NI- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OZ 17O-
<br /> PRIMARY CONTACT: 0 OWNER ,CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: C20G) GZ7.--'11to66
<br /> DC':-rc.,,IJ k uwI CONTACT EMAIL: ciotiz,,A . kcjoJ " ,1, twJ 5prun ICk .i Ir
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: 3HH Trr n3 ,r-4 -doll Eew,pr ,4' Contract Price of Work:$ IZ f C)Jb•
<br /> Proposed Use of Building: 3y,-) -Tr ansec,,,4kat✓e, &iv.,Pnta--' Heat Source: ❑Gas El Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: $Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair E.T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: 6-x{•oHrl . ,64,,nq .ur�.b 5r54'u,. +0 pro,rk. pro-i-c4,4.16:i 40 :..�,^.' 4'00l J-vtil-I-r,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture I
<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 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 I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System i 5 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# 0C Li
<br /> )1/i-0 +el
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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