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NM <br /> 4111 PERMIT APPLICATIO. <br /> a. <br /> BUILDING / MECHANICAL / PLUMBING / SIG_NL PRINKLER / DEMOLITION <br /> EVERETT CITY OF EVE MIT SERVICES <br /> 3200 CEDA EET, EVERETT,WA 98201 \, <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-885 I(E)everetteps@everettwa.gov I www:.'everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SI NFORMATION <br /> PROJECT SITE ADDRESS: .157 7 6,14p4 n.ei-- (,U AA) PROPERTY TAX#: a,g0Sr-OgDO 100900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. I (attach copy of long legal description) <br /> /1 <br /> CONTACT INFORMATION <br /> OWNER NAME: TO ,b gores 1 64 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 75bi C. (.-Ieal-(n,,t-- LA)Ay <br /> CITY 'EAS e,ce_Ak STATE (,<J IT ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: C.t-)5`�C�t pest pq 3Lu (G(Q,i/s 1/1i1 <br /> CONTRACTOR ADDRESS: STREET ii o li l £J C..J elp-GC.t,t. (A ty ScJil-C, d�GeQ <br /> 1 CITY Gam`_ / STATE (X,J'4 ZIP 1�j <br /> CONTRACTOR PHONE: L-07,5J Lj(y l) CONTRACTOR EMAIL: G(JS 01,14.1 cSlij►1 (4 Oa'AA <br /> CONTRACTOR LICENSE#(REQUIRED): J 5TO b 355-5 OS CITY OF EVERETT BUSINESS LICENSE#(REQU ED):AP W ET-39 <br /> PRIMARY CONTACT: ❑OWNER S.CONTRACTOR ❑OTHER(Please Specify) 4t04)9) 6301 t5)L <br /> CONTACT NAME; CONTACT PHONE: tf)5 75-4 W(o j7, <br /> t ?,mt k,! CONTACT EMAIL: Cc -.-fr,'-ti pcSIiH 6.4, A ct?:t c 5.4- F 1,..7 -'( <br /> BUILDING INFORMATION <br /> Existing Use of Building: 51-I2- Contract Price of Work: $ ---t-6- ;l`= `�' - - `D <br /> Proposed Use of Building: S FP- Heat Source: ❑Gas DElectric DOther <br /> BUILDING USE: NSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial Accessory Structure <br /> Type of Project: New Addition ,Remodel Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: - �Jtctec° L' 1S,I,KGi 1f'yv, yt2ct( vzL .t.Ie: rJv _ lf <br /> ` 5 Slily 1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): e"— <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> List of Fixtures List of Fixtures Count <br /> List of Fixtures Count /� List of Fixtures <br /> Count / <br /> \A/C—Air HN �aYtdt(ng Unit t Gas.?ping Backflow Preventer(I\nside Bldg) ' Shower,Tub,or Corr <br /> Boiler ,,.! Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> I hees Dryer / Heat Purructless l Dishwasher ( Sink-Residehtial(kitchen,bath,bar) <br /> Duct System(Remodel) , Refrigeration Drinking Fountain Sink-Utility, laundry, mop <br /> Exhaust Fahs,(Residentjat( Commercial Ventilatior 'F�bor�ain / Toilet <br /> E h gust Hood(Type-i) • (Not HdatJAC system) Hose Bibb'� Urinal <br /> xhaust Hood{Type II) �Nater Heater----, Interce r-Grease' / Waste/Water Piping Repair <br /> Exhaust Hood(Residenti ._, Wood Stove In ceptor-Sand/Oil Water ServiCe(be ind meter) <br /> Forced-Air Systems ) Ottaei r: lijt\ Medical Gas ' - Water Valves or Fixtures <br /> __Gs'ss Fireplace/Inse og Roof Drains WaterrHeater <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 /> C---Th PERMIT-#- r2 <br /> (7.f., -- i-.:1<3 \ <br /> —6—' Uri <br /> Owner/Authorized Agent Signature Da (Revised 10/10/2018) <br /> 12-- <br />