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<br /> PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER I DEMOLITION
<br /> ,,M� CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (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: I I I I 5'61`" , ),,b' PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: _Vote(co lvieri CO1 TENANT BUSINESS NAME(Commercial): men /j ,c,,,a
<br /> OWNER MAILING ADDRESS: STREET Jill (10f1'1, ,S.b. �51,4A
<br /> CITY .,.. reif^ STATE ;:i ZIP CW?
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: 11'1., yviack Rao P;1
<br /> CONTRACTOR ADDRESS: STREET 3 L.{I t3 t‘ivi, 5 ;,..-,,,,,
<br /> CITY. A 4.,,Ar ri STATE klir . ZIP COOL/t
<br /> CONTRACTOR PHONE: - it `< 7 CONTRACTOR EMAIL: , (454.1vt,140. :64 (r.,n-.),(rviGGxv 1, . Covv)
<br /> CONTRACTOR LICENSE#(REQUIRED): tm..r. LI T 1(-44 0ict t Z CITY OF EVERETT BUSINESS LICE. E#(REQUIRED): Cq4609
<br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR ❑ OTHER(Please Specify) ^CONTACT
<br /> CONTACT NAME: �� i� j.(m .yinCONTACT EMAILE.��s����H� � r,i,,[-
<br /> le Le
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ (f 19 7-i, C}y
<br /> Proposed Use of Building: Heat Source: OGas DElectric DOther
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Yrommercial DAccessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ORepair ❑T.I. ❑Sign OSprinkler ❑Demoli/tiion ❑Changge of Use
<br /> DESCRIPTION OF WORK: :Si►1tie le, t r' ov. { ever- 9R.s4;v�+1 5;1 4c layer- kui SYo54Wfl. W-. v,4L 4,4 I
<br /> ;Ante !Aye,-- l/2, 0,4 TY, w/te L cs,l oriel per •.J ' .4t.re.rs �c3. 5en,3le [Aye.- 6.0 M.t T
<br /> t- eAed to S c vt`� t'C It;Ito bia N p ta,4e po r' Movie,Pac-4c•ett,6 s e r.S. 2 0 roe')1.014-e, ce 1S c4cat't 1 A 9 V'-WAIT .
<br /> ASSOCIATED BUILD NG PERMIT#(if applicable): / 7
<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 -
<br /> 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 I 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.lam the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,
<br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> ner! uthorlzed gen gnatureNOV I
<br /> 'Date PERMIT#
<br /> Revised 10/02�8g I I � �)
<br /> �wt\�JI
<br /> 1 fZ
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