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II PERMIT APPLICATIC <br /> BUILDVNG / MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> Sc...... y CITY OF EVERETT PERMIT SERVICES <br /> �Il�l 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (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: 6,5' I, Cmc 5 (4\o RY PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6;61e_. s o4 S- CL/cL TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET g0 ++ U. CG;5,4 0t q <br /> CIN Ve.le,'r'�' STATE WA ZIP Yj Z‘) <br /> OWNER PHONE: (Wz ) $10 - 2Y17_. OWNER EMAIL: <br /> CONTRACTOR NAME: i er P .11 <br /> CONTRACTOR ADDRESS: STREET L.Oj c-21 SSt-. �J <br /> cm( /4au,.t4Lc.k. 1 tlrGcSTATE WA ZIP 1(30 13 <br /> CONTRACTOR PHONE: lam) 216 13 8 3 CONTRACTOR EMAIL: L5 r-% r Q t4.94'.4A c,,I- Cc)rrn <br /> CONTRACTOR LICENSE#(REQUIRED): F1 5 CIA 496 )3 1 j I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): rt.e , <br /> 0,511725 <br /> PRIMARY CONTACT: 0 OWNER Iii CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Grt� Se CONTACT PHONE: (2.46) 276- (3 8 Z <br /> Ata <br /> CONTACT EMAIL: 'vv."rod" Lu,{-,,,ta,(. <br /> BUILDING INFORMATION <br /> Existing Use of Building: du c�,-1w vt otC; Ir3i Contract Price of Work:$ )©i S'en <br /> Proposed Use of Building: '5 mt Heat Source: ❑Gas .Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ®Commercial DAccessory Structure <br /> Type of Project: ❑New DAddition ®Remodel ❑Repair CIT.!. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: AL / <br /> &vievc 4k aid bc.i,os.+� J 1�,4-cLrv,. 2;5,4, it new pfo,M✓ins IG^ C re Coit .;, <br /> ASSOCIATED BUILDING PERMIT#(if applicable):'Tejo G;-020 <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 3 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration 2 Drinking Fountain Sink-Utility,laundry,mop <br /> 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/.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.l am the owner,or I am 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 /> City of Everett Official Use Only <br /> PERMIT# <br /> t2,-26—re i O1-' 0b1 <br /> Owne Authorized Agent Signature Date (Revised 10/10/2018) <br />