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PERMIT APPLICATION <br /> „HOLT BUILDINI IECHANICAL I PLUMBING I SIGNIF- 'RINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: i(,6 El- TT yV 'A\ .A1 P1/41 Ai 2 Q PROPERTY TAX#:Alo s"-I i Uo3 c-c, O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C-L:t t v TENANT BUSINESS NAME(Commercial): :){ 4 ' <br /> OWNER MAILING ADDRESS: STREET !e sZ v a� _ IST°� 1'l4--w1 <br /> CITY fyl;,.i41 L_T"c: z„', STATE L ,1 ZIP 4/1.2 2 <br /> OWNER PHONE: vi 7 >- i S C 4. , -7 OWNER EMAIL: <br /> CONTRACTOR NAME: `-i C -i +,a l - PVC-- <br /> CONTRACTOR <br /> ,,f;;CONTRACTOR ADDRESS: STREET t/Lj2_6 2-ZI 5' c It-'(.-= <br /> CITY ) 'D(vtz,,A l STATE ZIP <br /> CONTRACTOR PHONE: zs 21.0- G s.- CONTRACTOR EMAIL: PGL) ,-t, 1-- () t)-OL <br /> CONTRACTOR LICENSE#(REQUIRED): j7]r {-Y =vZ Z C _� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: El OWNER jONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L12S- 26 c- . (vim-S �' <br /> ham`I .)c/S`--P CONTACT EMAIL: )-) <br /> BUILDING INFORMATION <br /> Existing Use of Building: _Contract Price of Work: $ 3 z <br /> Proposed Use of Building: Heat Source: ❑Gas 177 lectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ..2Commercial ❑Accessory Structure <br /> Type of Project: ENew ❑Addition „LjRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Z�vST��t tU ln/ 2C'Tur- � Curt {1 <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 /> A/C—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 /> '7 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/ 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 1 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 /> -4 -72— 2- -- <br /> PERMIT# <br /> OwnerlAuthorized Agent Signature Date (Revised 10/10/2018) �,l`/ <br />