1817 BROADWAY STATE FARM INSURANCE 2022-01-18

VIIIIIIII � PERMIT APPLICATION 'I BUILDING) NiECHANICAL/ PLUMBING /SIGN /SI IIRPINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 111477- 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: jq f t rem.,cS) Al/+Z PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: CAI, s 7f-t 6-42-S TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET ( g f nj c a a,J ,., CITY /LQ C &-- STATE civ ZIP `C� C2 t, Z-06 OWNER PHONE: 7- 6 � �/ 2 $! s G OWNER EMAIL: 111 P c7 s, JA Q u 5� �1 1'"1 f ml sit-t2 F-�f N-4 CONTRACTOR NAME: Cj n Se(ne 2 4n,2 P` CONTRACTOR ADDRESS: STREET l ( `LZ 4ALI`t "n S-4- CITY I)O'c'k'x2 I STATE 1.4)4 ZIP 12..cbO �+ CONTRACTOR PHONE: 42 5- Y t 1 9 66 cs CONTRACTOR EMAIL: • CONTRACTOR LICENSE#(REQUIRED):5ei!16)0,e. !j ( 6,3- C4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3 10 S Z PRIMARY CONTACT: I OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: r1 0 G L4( 'Z 8/ CONTACT EMAIL: G(L1 A�3i' ;-5-c)rLe.S t j v t 1 p Pj l�C� pt f`oh, BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$�`J O e,'"" Proposed Use of Building: Heat Source: ❑Gas OElectric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: $.Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Tye g4 do >1Qv fete- Q w•c> Rego ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION 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 1 Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems I 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 Official Use Only PE IT k 02 / 8 YV1V 0 tn./Authorized Agent Signature Date (Revised 9/23/2016)