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1 .ONNO PERMIT APPLICATIO,
<br /> 1 Eil
<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 �
<br /> Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: �(/I l�tthe4'/Ier� eJ ', Et /// 4 Wei PROPERTY TAX#: S i97Y1e-4,-, /
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) 5-Et ,47y,;C`i,,J
<br /> CONTACT INFORMATION
<br /> OWNER NAME: Q-oc t ' ek- 51f 6 , LL L TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 5 Z C S S. Z ,'C 4(,,e. / 5 ia . C
<br /> CITY Et,' l e STATE 14./(4- ZIP 21)--17
<br /> OWNER PHONE: 42 S-- 076- 7)'62S OWNER EMAIL: ,j oe. 21 4 b 42.3,.,t7d. I. Ci',"t
<br /> CONTRACTOR NAME: J M 7. Coiillor (- $, Z_(-L
<br /> CONTRACTOR ADDRESS: STREET Sul s S, z L' / /rr-e , 54,. /e C
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<br /> CITY 11 Qj L O STATE ) ,9 ZIP ZC_S.
<br /> CONTRACTOR PHONE: LI Z S- 076- 73675 CONTRACTOR EMAIL: jvc', Z/41 e-i/s-/G,1,CC)A-1
<br /> CONTRACTOR LICENSE#(REQUIRED): ).M'Z(:_c2CL g Sf�P/2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S'/F 9 I
<br /> PRIMARY CONTACT: ,OWNER 0 CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: el Z S— 76_ ? 'OS
<br /> Sod 2/iii
<br /> CONTACT EMAIL: J e , Z 14.4 t 2 '1 ilia. .Cc M
<br /> BUILDING INFORMATION Q
<br /> Existing Use of Building: EA:s i? Old ldri PAS -7�7 t.n. =5 Contract Price of Work:$ 153 vi a0O 3 % V (.
<br /> Proposed Use of Building: Ai c w 3C U(7.�- /r14/r,- G41,1 Heat Source: ❑Gas gElectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: 36 ❑Commercial ❑Accessory Structure
<br /> Type of Project: New ❑Ad •tion ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Changeof Use
<br /> DESCRIPTION OF WOR : 30 )9;n a lie ,4ine.{71i" /— Gin.7'S, 2 (../ 7),✓ic...,, 5,/,, S ;n �cy/,, 4/-t.,ei GI
<br /> f G✓k,Iij s�'A1e, 2 J
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): I lc'Jg( T t S 7'11 C? $ tie /9S 14 /-r2vdT SQ &A-f.}41 1319/7—o C C/
<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 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 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 end 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 /> IA
<br /> 12-7 y-z�-z6 P 21�()\ — 0elLk
<br /> Owner/Autho i ed Agent S, nature Date (Revised 10/10/2018)
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