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aimPERMIT APPLICATIO 7(tc,µ10irti <br /> al <br /> BUILDIN ECH •NICAL I PLUMBING I SIGN RINKLER I 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 Please) PROJECT SITE INFORMATION . ;::, <br /> PROJECT SITE ADDRESS: °o Oc k C\kk SA" £-ve..rt-1"'r c-vx+- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: a i r 1,ck-I cvv..1 cc'y`t;o,,--c TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET I I '3'L.. \ t-J Lp.14-tS1-»rC- 17 IL-\QC- <br /> CITY L A we 5 4C,VC"J S STATE i 41. ZIP c1(6 2,..S.fj <br /> OWNER PHONE: 'LC -1 Sb OL(?S' OWNER EMAIL: U�tGOJ r-rc`cA-or Q fF"0 r,vi U,t✓ (,v''\ <br /> CONTRACTOR NAME: Z}�.�.-u (2. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: Ili OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: y c 1 S-0 0 c-(-) <br /> VYv' t c-k'I c•,,i C arCDNIc:kcL CONTACT EMAIL: <br /> • BUILDING INFORMATION <br /> Existing Use of Building: `i.Qi- Contract Price of Work:$ 3S 000 <br /> Proposed Use of Building: t/(2- Heat Source: OGas 0-Electric DOther <br /> BUILDING USE: C, SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: DCommercial DAccessory Structure <br /> Type of Project: ❑New DAddition ElRemodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 9,,.6. L."›,e: - ' -r-e— 'o.ts-- "4-; I6lkit it =J / <br /> r 7 Ej_c__C-11e4--C t- / ?LV AnivIi-v I 1?f10r-cs <br /> r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 i Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer e/i' Heat Pump&Ductless I Dishwasher I Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remo ' Refrigeration ---A Brinking Fountain a. Sink-Utility,laundry,mop <br /> I Exhaust Fans(Residential) Commercial Ventilatior ---i----FtDi'Drain 1 Toilet <br /> Exhaust Hoes(Type I) (Not Heat/AC system) Z Hose Bibb Urinal <br /> Exh�alisf Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> 1 Frlchaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> f Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> l Gas Fireplace/Insert/Log Roof Drains i 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 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 /> PERMIT# <br /> ©/ /22. ('t,o IL ZUO1 '6,(6,9, <br /> Owner/Authoited g‘nt Signature Date (Revised 4/15/2019) <br />