118 SE EVERETT MALL WAY 2019-06-24

PERMIT APPLICATION■ #111. BUILDING/MECHANICAL/ PLUMBING /SIGN I 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: (I S e MQ!I WC PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: t- Orr") TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET G3€ /-4.. /OT'-' r�- I . CITY �er"e'-�-1 STATE \A/TN ZIP C3' � OWNER PHONE: i ) 50! OWNER EMAIL: & Cpj-,p;r-)( i"`/, ( �O-yy- CONTRACTOR NAME: J CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of rk:$ �9, oar Proposed Use of Building: Heat Source: ❑Ga ❑Electric ❑Ot Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ■Commercial El Industrial Type of Project: ❑New DAddition ❑Remodel 0 Repair ❑T.l. OSign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: , � t D),,,, w- Ci,, �nC.l psC.c-i-e,. cst_e-cput-t'd sc�-1 ,bo-cb- cam-. cs-t- �,c e� c4- bui i I d t ASSOCIATED BUILDING PERMIT#(if applicable): 0-2I v'7 7 c 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 Fi.. es #of List of Fixtures #of List of " ures Fixtures Fixtures • Fixtures Fixtures A/C-Air Handling Units He- -ump Toilet Backflo 'reventer(Inside Bldg) Forced Air Systems nit Heater Bathtub Ur:•-: Gas Piping Boiler Lavatory(Wash Basin) 'rinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes ■-ger Hookups Other: Clothes Washe Medical Gas Ran. ' ood Water He. - Other: E gust Fan Sink -rvice/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 EveretttOfficial Use Only FFVV � + - -CDoa . `e. gent Signature Date (Revised 9/23/2016) I1