811 SE EVERETT MALL WAY BASE FILE 2019-10-07

PERMIT APPLICATION #/#1,4,FIL BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 i FAX 425-257-8857 1(E)everetteps@everettwa.gov i www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: Pf if 5E 9r /fr L- 644 r PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: f 4'A(AJ 06SSG f TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET PO C /, Q p CITY STATE te.//A J ZIP =` � (c9:) .Yj OWNER PHONE: OWNER EMAIL: v-Ad0 ye,4 91---4.-1'" // GOi' CONTRACTOR NAME: Wan/ C '7/L I (J CONTRACTOR ADDRESS: STREET re) j Y /7p -9 0 CITY A f/GL. C IL STATE zip, " P CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): J HVc fjp cloc !-6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):V 1 ,i a1 PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) p- , CONTACT3 EFNAME: CONTACT PHONE: .2.06 9 c/' �,lo li 1k? CONTACT EMAIL: (G' LF-L) ! (-f33�>t roc.,ion//lc.,C. BUILDING PERMIT APPLICATION Existing Use of Building: 6 y4ieyela Contract Price of Work:$ AO)PoO Proposed Use of Building:C )1 f J4 / Heat Source: &as ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial 0 Industrial Type of Project: El New ❑Addition gRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler grDemolition ❑Change of Use DESCRIPTION OF WORK: 0,4e) /5 ,r c0Ll iC j il*eAv oldrOb OVII1 ASSOCIATED BUILDING PERMIT#(if applicabl ): °++ -� l Ips MECHANICAL PERMIT APPLICATI PLUMBING PERMIT APPLICATION Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New Addn _Alteration Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) ForcedAirSystems 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-, Chemical or Water No. 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,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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett OfficialuUse Only � PE�I��I,�`l. � 1 Owner/Auth zed Age Signature Date (Revised 9/23/2016)