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

�/�-o�- oz� PERMIT APPLICATIO� BUILDIN�MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: �Z- l SL �1/c�v�� i�j �`� PROPERTY TAX #: LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: S� �C-� ZZ� G�„�GV�•�-��S'e S � LC TENANT NAME (If Commercial): �-%.� ] MAILING ADDRESS: sTReeT cirr PHONE: CTOR NAME: ��'� � CTOR ADDRESS: srReer CITY STATE OWNER EMAIL: �- /�- � � � /� �L �v G ��L ! � RACTOR PHONE: 5[¢Q _ ��a / — ,S's�v n RACTOR LICENSE #(REQUIRED): �T�✓ � �RY CONTACT: ❑ OWNER L�CONTRACTOR ACT NAME: � p� ��P�—�� � STATE CONTRACTOREMAIL: p,,,a�,y��% e�� ��S.S � CITY OF EVERETT BUSINESS LICENSE #(RE ❑ OTHER (Please Specify) CONTACT PHONE: 2�j _ �� /_ � S (� � CONTACT EMAIL: 1 t�a�� r�� ,� �c,i t�U f✓1' ZIP ziP � ? �(�-l�/J.vt� . D ;�— UIRED): QS Z Z ,tt.�� i'.�,-G, _ d' � BUILDING PERMIT APPLICATION : �'" ��----� Existing Use of Building: Contract Price of Work':� �.-� � � a - �— Proposed Use of Building: Heat Source: ❑Gas"°. ,. ❑Electric _nOthe� Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair �-f.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: > �l �� /.�.�� o v� /i�Zl� �D,` /-� �� r wCG� U t� �r e2� ��'�s �-s r-6� � ,'�, ASSOCIATED BUILDING PERMIT #(if ap icable): PLUMBING PERMIT APPLICATION Type of Project: _New _Addn _Alteration Repair # of List of Fixtures # of List of Fixtures Fixtures Fi�rtures Toilet Backflow Preventer (Inside Bldg) Bathtub Urinal Lavatory (Wash Basin) Drinking Fountain Shower Floor Drain Kitchen Sink & Disposal Grease Trap Dishwasher Roof Drains Clothes Washer Medical Gas Water Heater Other: Sink (Service/Bar/Mop/etc.) Other: ACKNOWLEDGEMENT: ! have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply wifh current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations fherefrom. Deviations must first be authorized in writin� from the Building Officia/ before being authorized under any circumstance. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, and I comply with th� State Confractors Law 18.27 RCW and 296.200A WAC. � � City of Everett Official Use Onty PE IT#� � - � � _ � � ��.;� _ ��)��` Own Authorized Agent Signature Date (Revised 5/20/2016)