221 SE EVERETT MALL WAY A T AND T 2019-03-18

IT APPLIC'ATION BUILDIN ECHANICA / P UMBING / SIGN ��CINKLER / DEMOLITION VERETT PERMIT SERVIC 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits CONTACT INFORMATION OWNER NAME: L Zz r v� TENANT NAME (If Commercial): � OWNER MAILING ADDRESS: srReer CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: � CONTRACTOR ADDRESS: srReeT � ��Ty � STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): � � �� PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER (Please Specify) `✓� CONTACT NAME: CONTACT PHONE: � � � CONTACT EMAIL: � � � � � BUILDING PERMIT APPLICATION Existing Use of Building: � Contract Price of rk: $ 0 � � �r �� Proposed Use of Building: Heat Source: Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ommercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: // / /i i. �r/�en �vk �lI- �I(�W G�jl�� ��/�� c�-� vu>�l—�f��"�c'<<S �G15• f�X��s. .lv��5��it�,.r i'��` �J �r� � � �1ps °� 1, �.� �� X�r�s , �� t�r �� , � � � �is�.es, �G �Ce '�`C� c►�CPs� bl e , ASSOC EB'B LDING PERMIT #(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERIVIIT APPLICATION Type roject:�-_ New Addn _Alteration _Repair Type of Project: _New _,Fl�ddn _Alteration _Repair Fixtures List of Fixtures Fixtures Lisf of Fixtures Fixtu es List of Fixtures Fix�tu es List of Fixtures A/C — Air Handling Units Heat Pump Toilet Backflow Preventer (Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory (Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink & Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: SPRINKLER / SUPPRESSION SYSTEM Number of Heads 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 current federal, staie, and /ocal law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must firsf be authorized in writing from the Building Official before being aufhonze under any circumstance. 1 am the owner, or l am authorized by the owner of this property to perform fhe work for which application is made, and 1 comply with the State Contrac rs Law 18.27 RCW and 296.200A WAC. Signature City of Evereft Official Use On/y PERMIT # �� l��c��— ��- (Revised 5/20/2016) `j �Z