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(41Err PERMIT APPLICATIL <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> 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/perrnits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /723 (.Ovi A-IZ-D PROPERTY TAX#: 093??zz390/Zoo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: yiA\\{l. (I i L__R.pt-vv, TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET /ZZ.3 6...01h6 (� 4-11L <br /> /4,5 CITY eveie_�-T- STATE �A• ZIP 9$?O) <br /> "1 OWNER PHONE: - 37e - 56 2-5/ OWNER EMAIL: kill 6/L NAKAQ ')/14AIL , LDft't <br /> CONTRACTOR NAME: 14004 E wvg_K (4046772 U G_T(OAI /.��(r -ki... C l LiErZ <br /> CONTRACTOR ADDRESS: STREET 7)O iO)C 1/4 q ' /� <br /> CITY ,4© .A4, QC;.. STATE J`tT ZIP 9 Pz 72, <br /> CONTRACTOR PHONE: ql_`5 'Fill—Z6 p 7 CONTRACTOR EMAIL: `NDt-44-Q NC ,U6- Aa0f2( .�, <br /> CONTRACTOR LICENSE#(REQUIRED): 4004e WCS $f6. LQCI CITY OF EVERETT BUSINESS LICENSE#(REQUIRED <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) 6703 01 Q <br /> CONTACT NAME: CONTACT PHONE: (4 z,5-.9G/( _z6 g 7 <br /> -So N-14 OL(vete CONTACT EMAIL: '3:44,I1/44 a...), !' gee(-f`biet.K S(""r4 (I✓,- i C.f3wk <br /> BUILDING INFORMATION / <br /> Existing Use of Building: Contract Price of Work:$ 60/000-2 <br /> Proposed Use of Building: 67 4 44rJ',E /Aro(,t Heat Source: ❑Gas Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse 0 Duplex ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: 126ew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK:-� -O t�g(S�ts(-, A c cp7Js' ,tAcr 2CPr('Z 64,1)46Lt. <br /> t.,_)i,k+ f u 5e-cero.l 6 r;:..mot _. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): *01/41\k OkNQ, t QO& <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) 7 Shower,Tub,or Combo <br /> Boiler Gas Range / Clothes Washer Sink-Commerciall(3-comp,prep,floor) <br /> Clothes Dryer I Heat Pump&Ductless / Dishwasher Z Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) \"--}-._.Retrigeratkkp Drinking Fountain / Sink-Utility,laundry,mop <br /> Z Exhaust Fans(Residential) Commercial Ventilatior Floor Drain _ I Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) / Hose Bibb Urinal <br /> Exhaust Hood(Type II) I 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 1./1j attartcLeatefi <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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use(Only <br /> 3 `it /9 PE .co..(�W ( <br /> Owner/Authorized Agent Signature I Date (Revised <br /> 5 9 10/10/2018) <br /> L <br />