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I PERMIT APPLICATION
<br /> BUILDING / MECHANICAL 1 PLUMBING /SIGN /SPRINKLER/ DEMOLITION
<br /> EVERETTCITY 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 BIIack Ink C nly;Please :,.., : PROJECT 51TE>0:ORMATIO1 i � ., .. ..,.$.:,y .. . ... ,,.,., .,,. .., _.,. . ..,._..
<br /> PROJECT SITE ADDRESS: 211 0 ' AVEPROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> Mingill.M.F0-EiMinifigaggiggINARM:511.-NR:iniFtioNlikettiOtittMOIONIERENVERIFFERMINNORMinna-
<br /> OWNER NAME: AA O A)1&L'Se TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS{ STREET 2-110 (2-1:n�V AVE
<br /> CITY ( r V& - STATE LJFI ZIP q e'2....0
<br /> OWNER PHONE: �25 .�5 • 3 OWNER EMAIL:
<br /> E >
<br /> CONTRACTOR NAME: PK,y'c S P t VV\,I r�1 , /._.t..C,, j�
<br /> CONTRACTOR ADDRESS: STREET I'<6;�-- S 140\. t f� ,&) (� �j
<br /> CITY \--(-11r191-04,... STATE A ZIP -/, *z.3
<br /> CONTRACTOR PHONE: 4-2-S, j'O. 4O CONTRACTOR EMAIL: 7(Tt Y'k5 p)(4 v410j✓ ,91/Ka i, ccn'..
<br /> CONTRACTOR LICENSE#(REQUIRED): IS i 4 ,ON CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): l{-3'Sgq
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4z5 i 37 0 r 4-61���o/ CONTACT EMAIL: f9 vKk &A,i @ 0 yvl,ts/ /, C OVV..
<br /> H v.. JEW, W1iNG 1NFO0,010N _.. :.. .,,m .. . ` ... .,
<br /> Existing Use of Building: Contract Price of Work:$ 4.50v
<br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU 0 Multi-Family-#Units: El Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition 0 Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ?- ? l a Aty- w 1,4 4'L- v ,, 4,A,k,less.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MESHANICAL PERMIT, ►PPLICA,TIO[+1.,. .z, _. .t _ o: _o .. C._ .. .. ;
<br /> FixtureFixture Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures, Count List of Fixtures
<br /> NC-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 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 /> .ig„V SPRIINKLER 1.S;.UPPRE`SSION SYSTENC ; ,,, Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System No.of Heads.
<br /> ACKNOWLEDGEMENT:I have revie,ed 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 loc. . . T -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 bei •autho%ed under any circumstance.I am the owner,or!am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the =te Co, actors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT.
<br /> • S 1 il,0-0� I
<br /> Owner/Authorized Agent Signature mate (Revised 4/1 /2019)
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