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= PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> EVERETT 32CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3'toS-f/2i 14., Ave- rl W 04 PROPERTY TAX#: 00L-3$1 S 200 0 200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> rr n CONTACT INFORMATION <br /> OWNER NAME: Lorne 2.LorC1 I` .,4,- ,iq kU1- ENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 2522 �F f 3$ — ?L, <br /> CITY j r K Q f1 STATE Wh ZIP O 3+ <br /> OWNER PHONE: 2 0 (o G S '- 9 3-7 9 JOWNER EMAIL: LUrn e- tZ c o oA <br /> CONTRACTOR NAME: O t=(I r'd owner <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BU INESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET $'22- 139A, 11 <br /> CITY OLItA STATE LJ ZIP O <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify)CONTACT NAME: CONTACT PHONE: ZQ S Of_/' 3? <br /> L u r.. 1 C.Vr4 CONTACT EMAIL: L—Urne T (2- <br /> �" II BUILDING INFORMATION <br /> Existing Use of Building: A I c�rcn TLt I o c.--tS Contract Price of Work: $ <br /> Proposed Use of Building: C',S% 'I;cl "}U -ftsxolrd Heat Source: Zas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse []Duplex ❑ADU ulti-Family-#Units: fy ❑Commercial OAccessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel epair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition ❑Chan a of Use <br /> DESCRIPTION OF WORK: (V o al KrA�1l1 r•5 f/Q d d CnS -{•a O.i (d ir. Twa,.♦ -Fu a1-�' k�i �--iv I_ <br /> L1 u,,.�p1la..t� `l'hiS b..i Idl/l� '►nspe�{1ur, Ptlti+►:r is Slop Kt '+' ld ir5P. ti0n +0 ra IOC► <br /> n�'trn4i'1 nn a P�uPar} IHJa�►�k..a.. Cam_ Cpde U �C Vtola-�i unS = vVi�l `l-ker Loon <br /> d i r Q.C*t y W t t4' f'�s, j n 5 ape c,'wf ' 0 C u rr-C�"(�ny W o,- ne&ded +v br.n q vhm'-'fie +0 c u f�l i an ce <br /> ASSOCIATED/BUILDING PERMIT#(i ap licable): J <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 1) (Not HeaVAC system) Hose Bibb Urinal <br /> Exhaust Hood(Type 11) 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 I INo.of Heads <br /> Chemical Suppression System I I 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 mstance./am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply wi the State C actors La �27 RC nd 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> / xU <br /> Owner th rized Agent Sig T <br /> ture Date (Revised 1112212019) <br />