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PERMIT APPLICATION■ <br /> "1111P711:r? BUILDING/ MECHANICAL/ PLUMBING/SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 120 5 C2AP 5MAn) 194'1 # 109 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: R.,by s 4 r- 1 ►7,sT/LLr A) TENANT BUSINESS NAME(Commercial): 5L0,2_,.144-Ea. t )7 sTiw 4 <br /> OWNER MAILING ADDRESS: STREET I Z O 5 C.2 Ak-FTS&N.AS L )#'i It I0 <br /> CITY 1 V f-�L 'T �" (�A STATE ZIP 9800 ( <br /> OWNER PHONE: 2e:›6 3 69 O 73 9 OWNER EMAIL: t N k=0 61...va✓�7LQr7'577/ i.04 c�•� <br /> CONTRACTOR NAME: Litz 2fZ t S i6 !J <br /> CONTRACTOR ADDRESS: STREET 7 lCO HA2 D Stn, Q.e> Q <br /> CITY v STATE A ZIP /6 Zo 3 <br /> CONTRACTOR PHONE: LJ as —.I"74o gg3s CONTRACTOR EMAIL: Accooc.rr-5 c) 3$,52_24'' tC Al , God <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: la OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 4.4 NYD/ CONTACT PHONE: Z O b 36 cj d 7 3 cj <br /> CONTACT EMAIL: k@ 2_e.s�Tfi20t5'7744...,US , Co-"'. <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 2.852 <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric 0 Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �• �t t I" <br /> IY/�►� J- �l <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 /> 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/: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 tam authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#\\, 1 DOS <br /> IS <br /> 2(2?�19 <br /> Owner/Autho ed Agent Signature Date (Revised 10/10/2018) <br />