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= PERMIT APPLICATION <br /> BUILDING I IICHANICAL/ PLUMBING I SIGN /—<INKLER/ 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue+fir 441 link tlxtly Pile*se)..:: . eRQJEGT,SiTEISKO. 1;E!tjO:, .., .ti '..7...._ EEi .. <br /> PROJECT SITE ADDRESS: 8 6 0-Kei f i 1,4 a,v, e t l 11 V PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision (']YZ""Lot No. (attach copy of long legal description) <br /> -7M^ <br /> a � `t u r M* <br /> OWNER NAME: Ai t ),(Q TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: ,) (9 l 3 C OWNER EMAIL: <br /> u se'! rew ».w. Fir•.. .aay. 'd- _ �. magic-.gym a.. cknh.. vvuvmammtnatt mow'des+rma-.wxrw+:wxu r. a.W++vvxv+we ,W., M. <br /> CONTRACTOR NAME: (Id.Sk--kk./0 fr\e.c- CaSo -oPet ( /r� /Zoo frvti SerU('cc U C <br /> CONTRACTOR ADDRESS: STREET n `n <br /> CIN (-e S-Q,T(A Cale STATE (k ZIP 1 YO Z 3 <br /> CONTRACTOR PHONE: 253- a ( l- al y y CONTRACTOR EMAIL:70/s rOO('--IA 3 c' "Iat^o0• C.au-t <br /> CONTRACTOR LICENSE#(REQUIRED):CCT 0,J i$ ,: j 4f.) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 47p OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: g5-3 - Z (7 - (,yvy <br /> \`ZJ sk0,W 1k4 k-r Lc-So Va-e 1 CONTACT EMAIL: 5OL ,l."-e <br /> z-, _ v - r _, a.e.4 010-N Q I YAtO# S,r i _ : .' ..-. s. g_ .. <br /> Existing Use of Building: Contract Price of Work:$ g )v <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair Oil. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: 2.{ 6r f .c (54- 5 ,r(ot' t i e.54-c, If ri Y VJCCXJ ) 1—e.._,0- <br /> CIS Ifk <br /> gi. S�ck (` '30 -bx(-- Cov-tpo 5-,� :ov . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): f is rooF I S-k-Ai -1 /o rt,or--6,-Art`cv' c <br /> MECHANICAL:PERM1 <br /> ' I�. ��PLu„„IYIB�fiI� P IT�'F+LIC/4'�IONa , <br /> � ,T Ajh-PL�C:ATI<9 . : .�.... , ,.., _� : k S� <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 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/,S;UPPRESSION SYSTEjIVI _ 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 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 /> IBt i S nN W i�ri CA DQ .,%/1°6Z PE S©�F- © <br /> Owne/Authorized Agent Signature Date (Revised 4/15/2019) <br />