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= PERMIT APPLICATION <br /> BUILDINGIDECHANICAL I PLUMBING /SIGN 1•RINKLER I DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: )(?) 9J►(00()A I ,' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision � Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:C h(+; O✓L.x.S 1 ¢ 14 IcCaa 4, TENANT BUSINESS NAME(Commercial): S Jc.t 4-e_ '—u C r" <br /> OWNER MAILING ADDRESS: STREET 14 (} Q C o a di a <br /> CITY 4 tie-CV- 44 STATE w ZIP - C 7 -C), <br /> OWNER PHONE: Z.06 4 y I 2'! OWNER EMAIL:C14. -$C:,f'•e S. " J t"' S- 46"5 / - Fore"' cad,. <br /> CONTRACTOR NAME: C pctI i 4-: A 9 <br /> CONTRACTOR ADDRESS: STREET Qa <br /> CITY €-- STATE ZIP g V Z o I <br /> CONTRACTOR PHONE: u L' ' 7—S b 20n}$ CONTRACTOR EMAIL: 7.0a C o Z÷ ?Pr:A (-�1 s lr ela•'f , co <br /> P <br /> CONTRACTOR LICENSE#(REQUIRED): 5 c0t6.O & g(b L.1" CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)C( es LI 6 <br /> PRIMARY CONTACT: AOWNER ❑ CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z. n 4 $'L) I Z $( S- <br /> Ck(' `` CONTACT EMAIL: c cs. �'o tie ul T ' r�� 54. 1 -e .Cove., <br /> BUILDING INFORMATION <br /> Existing Use of Building: T^g R r 4 e 4 c Contract Price of Work:$ cj 067t7 <br /> Proposed Use of Building: l7A "'"— Heat Source: g€as ❑Electric DOther <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial DAccessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel ORepair DT.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> e?Ai r c, f v.z. k e p <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads. <br /> 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 <br /> 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 <br /> Building Official before being authorized under any circumstance.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> )Cityy of Everett Official UseOnly <br /> .L/l /2 Cs. PERM)2/Zi <br /> Jhorized gent Signature l Date! (Revised 4/15/2019) J/ <br />