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® PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> EVERET CITY OF EVERETT PERMIT SERVICES <br /> T3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASNiNGTON (P)425-257-8810 ) FAX425-257-8857 J(E)everettep5@everettwa.gov I www.everettara.goWfperm)ts <br /> (Blue or Black Ink Only Please PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 31 e)S tires s c k ale��tr f vz trt71. W#4 PROPERTY TAX Alt: 00ft-3 81 $Z.0®® 2_00 <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Loent Ra c ur� oc UX- ENANT 13USINESS NAME(Commerclaly <br /> OWNER MAILING ADDRESS: STREET f 2-5.2•2- t, F i 3$ _- PL y_ <br /> Crry j r ik a^ d STATE j"� ZIP <br /> OWNER PHONE Z.t5 (m GS — 93-7 OWNER EMAIL: Lore rz CQ q•t t • c-OV\ <br /> CONTRACTOR NAME: _ , <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUefNESS LICENSE#(REQUIRED)— <br /> CONTRACTOR ADDRESS: STREET y Aj 13 S <br /> CITY <- sTATE W <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL,, <br /> PRIMARY CONTACT: OWNER O CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ( 5'0 - 513 <br /> L U r,, I C-{, r4 CONTACT EMAIL- <br /> BUILDING INFORMATION <br /> Existing Used Building: (-e- I ao' �1 Iwk2c —.'tZ Contract Price of Work:$ <br /> Proposed Use of Building: j Heat Source: Mas I_IEfectric ®Outer <br /> BUILDING USE: OSFR OTownhouse ODuplex OADU ulti-Farnil -#Units: OCommercial OAccessory Structure <br /> T pe of Pn*ct: ONew ❑Addition ORemodel ! e air OT.I. OSi n OS dnkler ❑Demolition ®Chan a of Use <br /> DESCRIPTION OF WORK: l�ta ai dCAA tt'P' ^S! A i i 0,.S +C' +U <br /> � b�..i ldi.tij - nSp4LC.7h>a.-, P�r-tro.::'F" gcS Sv.�ts �fi -�, ~�•;c �e� t���.crti�a°� `t2 fit.�t°3ct-f'— <br /> ASSOCIATEYBUILDiNG PERMIT#(if applicable): 14J rsr f �a -C� -$-� �?r:n acre - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Flrture Fixture FixtureCount List of Fixtures counr Gist of Futures Count List of Fixtures Count Gist of Fixtures <br /> AIC-Air Handling Units Gas Piping Sac"ow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commerciat(3-comp,prep.floor <br /> Clothes Dryer Heat PumpSDuctless Dishwasher Sink-Residential(Mchen.bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utitity,laundry,mop <br /> Exhaust Fans(Residential) Commercial Vertilabor. Floor Drain Toilet <br /> Exhaust Hood(Type 1) (Not HeatIAC system', Hose Bibb Urinal <br /> Exhaust Hood(Type 11) Water Hewer nierceptor-Grease WastetWater Piping Repair <br /> Exhaust Hood(Residential) Wood Stove nterce tor7sanufoa Water Service(behind meter) <br /> Forced Air Systems I 101her Medical Gas Water Valves or Fixtures <br /> Gas FireplacellnserULog I I Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other <br /> Water Suppression System I lNo-of Heads <br /> Chemical Suppression System I JNO.of Heads <br /> ACKNOWLEDGEMENT.l have reviewed this application and confirm the information contained herein is true and cwrect.Work done pursuant to this permit trust comply with <br /> current lederat,state,and tocal law. The granting of a permit only authorizes approved Work and no deviations therefrom.Deviations must first be authorized in acnitmg from the <br /> Building O#iciat before being authorized underanyr ci mstartm.f am the owner,orl am authorimd by the ovmer of this pfoperty to pen'arm the work far which application is made, <br /> and f comply wiA the State C cfors Lacy-?8 2-7 RCW�nd 296.200A wAC. <br /> I s. City of Everett Official Use Only <br /> f PERMIT it <br /> Owners ed Agent Sig Date (Revised 11,122r2019) <br /> ._._____.._............ <br />