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III= II PERMIT APPLICATIC=..
<br /> MI
<br /> BUILDINL+nECHANICAL I PLUMBING 1 SIG&'J1 UPRINKLER/ 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 or Black Ilnk Onl r Please, PROJECT,SITE NFOR**iti0 E. .. ,..P, ». ... . .It ...,..tEg ...E
<br /> A PROJECT SITE ADDRESS: Z°30 We--4---ivto y-Q AUS PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ,n,.. CONTACT INFORMATIOI+t,,., , , >,,..
<br /> OWNER NAME: Li-I--y o-c E V-e.r-e- -1-- TENANT BUSINESS NAME(Commercial) f \b(s ti k..(
<br /> OWNER MAILING ADDRESS: STREET 2930 t_ ore. A- N.).)Ztd4c.
<br /> CITY Eu Ai-e--- i- STATE W A ZIP 9 a ZO I
<br /> OWNER PHONE: 4 2-5 - 512- (o 1 b-/ OWNER EMAIL: i 2`na.yr j 5 r e-A-{ t st Ov
<br /> CONTRACTOR NAME: j r►r y S fg v\
<br /> CONTRACTOR ADDRESS: STREET -71-100 I'4-a-v'r,4e Sov\ .d• p 9
<br /> CITY Ev_e..{,e,- - STATE (,JA zip g 203
<br /> CONTRACTOR PHONE: 425 - 77 t'o "lsg 3 5 CONTRACTOR EMAIL: j yt f--o @ be Y-y S i \ •c 0 vvl
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(i‘.3 VEQUIRED):
<br /> PRIMARY CONTACT: pl OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: Je 4- I-kyrV S CONTACT PHONE: t-f 255 - 512 - 6(6.7
<br /> CONTACT EMAIL: J e..ka:.fl i Se 0`e-sre++wa. n 0
<br /> B
<br /> 1,111.DlN iM+IPi?RMMIIATiosangona ,,,,, , ,,, ,, , ,
<br /> Existing Use of Building: O4-(c S?e't'e-- Contract Price of Work:$ (4,813 •b3
<br /> Proposed Use of Building: Sam- Heat Source: OGas '®Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: lECommercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. ElSign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: i h5k11 1,. e,,,„ b,,i tdi( s i gvv..rse 0, ere,1,- of- bviial.i Ai
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IMj1ECHANICA0 PEittMjt`T APPLICATION, ` ...... .. .......r: r,A RL . MB 1401 ERN11'T P.410ATION ,. ,,. .;
<br /> Fixture Fixture 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 /> SPRINKLER,I 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.I 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 c ly with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> r 5 /Z3 ) 11 PE�ks90 —C°9Owner/ uth ri ed A e t Signature Date (Revised 4/15/2019) t/_ )
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