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PERMIT APPLICATION
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<br /> BUILDING -CHANICAL/ PLUMBING/SIGN / INKLER/ DEMOLITION
<br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue ni Black,Inks Only Please] x ..z,.t PRtkJECT SITE INFORf kit► 701 I .,.. ," . , , ,. , ., ,. ,S. ,rt ., a ..
<br /> PROJECT SITE ADDRESS:7/3 Cplitt at �LI PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> (NI O
<br /> , . ,-, a y: CONTACT tMA1 ION
<br /> OWNER NAME: Iii C C. Y 1 ezEf'0 TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET I C,DC CO/ t j11 u _ ride,- A 1 v,(J/ ///��� //
<br /> CITY ` OL�.� l i , N STATE fC ZIP ( -CJ 1341
<br /> OWNER PHONE: r G2,69 OWNER EMAIL:_ran 41/...iv ( 4, .._: .,..,,, �,�
<br /> CONTRACTOR NAME: G.-epAc )v jD/vj/nk)/1/2.. '
<br /> CONTRACTOR ADDRESS: STREET '(Q 11 S I Ci i,,ASi-
<br /> CITY G e.(n"6 STATE1.)0&� ZIP q X ( x,03
<br /> CONTRACTOR PHONE: 2OCg f) .o -{3 CONTRACTOR EMAIL: O� cwtvle, G)Beckenyl �Ur iii ,kT
<br /> CONTRACTOR LICENSE#(REQUIRED). k bAA, • CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: ❑OWNER .CONTRACTOR 1'OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: -LOG) 1122, 5-T t
<br /> ,If).i`Qi\ S CONTACT EMAIL: n U 11Ata,.c .-P i/i )ea i/ 4 .t r`(-rrA f
<br /> w,a , . n _ .. ...BUfLDII+fCs,(ll!(1F.O`RMAT1OI ` r . I , ,a . . t . , ? qi
<br /> Existing Use of Building: Contract Price of Work:$ a-(`)6
<br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler CI Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: x
<br /> Kr -V A ^Ci Zt` c>-'i--t), CL- ed Wks ,lit p U of pi
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> 0(ECHANIC4:PERMIT,A 61.04 TION,y ..y .. B NG PERMiT I LIC TION ,,. M ,
<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 Sirik-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 /> ,,',.i*i IPIKJ ER,I,SUPP'RESSIQ:N,SYSTEIIJ[ ' j 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 'rcumstance.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made,
<br /> and l c ylr,-- 'h the State Cors Law 18.27 CW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> I Air
<br /> � � � 1 � � .PERMIT
<br /> VL-113 °Ao -r ©0c
<br /> Owne orized Agen • . ature Date (Revised 4/15/2019)
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