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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> 4.101- <br /> PROJECT <br /> I <br /> � y <br /> PROJECT SITE ADDRESS: f 0 10 'S C 'iµtJ EC.cz1.- MALL &i-'P'1 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> .� , INFORMATION, .._, . , <br /> OWNER NAME: £vv4L i pIALL, taw-tce i3Lot, LLC, TENANT BUSINESS NAME(Commercial): ILFOL,G <br /> OWNER MAILING ADDRESS: STREET /OW to <br /> CITY elfe> STATE (A)A 21P `TY-1_46 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 7OR(3 <br /> CONTRACTOR ADDRESS: STREET ,ja(t S 3 <br /> f (1 '� Avc5 <br /> CITY -f f 5"T`v EI'5 STATE W ZIP 'r Z;& <br /> CONTRACTOR PHONE: If KLi 6 los 3 CONTRACTOR EMAIL: Mte.,4les.^ZcoN cz ts'ci` ^ Coote% <br /> CONTRACTOR LICENSE#(REQUIRED) �D(L?ENt de BR,6?5- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: 0 OWNER '$,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: E-(2S..L`(Gt 6 a <br /> C-432.,C3 6-3 CONTACT EMAIL Poo, k e, , c ,t' <br /> Watlaigi <br /> Existing Use of Building: .4-t?Ty of—o--rc -; `.141..cyz Contract Price of rk:$ 7,4'dc-) <br /> Proposed Use of Building: Heat Source: /Gas VIElectric DOther <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units:' RCommercial DA •-ssory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair Eta.a. ❑Sign ❑~arinkler ❑Demolition (Change of Use <br /> DESCRIPTION OF WORK: <br /> Re a c?--Y Oct U-'.'l-vim v'(9 Y t.-vz+-,.., i-Lc�c�� qL.41-1,-, P4o0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .f' s HANICAVPERMIT APP1L CA 'lIOl+;'�...1', 0f,0. t=4 PL:UMBIN IEtrt t'I'ZOPUC IO ,... „ <br /> FixtureFixture 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 /> 5 Exhaust Fans(Residential) Commercial Ventilation 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 I S,UPP,R"ISi`SiON SYSTE1 _ Sewage Ejector or Sump Pump Other <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /2-/771-y PERMIT#/1 ^ _O s <br /> Owner/A horized Agent Signature Date (Revisedse10/10/2018) /L <br />