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(46-fr PERMIT APPLICATIONS <br /> 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: 6 i4„.• L s (e�nrF-- CCC[N O TY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. att ch copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: ' f <br /> CONTRACTOR NAME: ivInirE T&c&�'R_`4S ,tel o 'c ��` \. L-L-C- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY // STATE / ZIP <br /> CONTRACTOR PHONE: 1 .`„�l0(tri CTOR EMAIL: NJ R. // 4 ')? u/A-��+ , ' . - <br /> CONTRACTOR LICENSE#(REQUIRED): e- ihL'-gi�YP4;- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED . h[i�L�N <br /> PRIMARY CONTACT:,�OWNER ❑CONTRACTOR 0 OTHER(Please Specify) ����Cu.�i.��� �'� <br /> eV <br /> CONTACT NAME: CONTACT PHONE: R 7t - 330 .— O J 3 9 / <br /> ��%/ / l2U(tVie6.s CONTACT EMAIL: A)2 t t',,,j/j�5 4,z'- 7 .,,,'7`(°'II <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex :VDU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> v_tio,c_e_ 6 _a--(),(:, .,( (c22_,-Ae_s (- ,,Jc._)cip_14 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): r"Std <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICAION <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 /> 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 /> • <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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 42,4,2, City of Everett Offiiciiaal Use Only <br /> r) <br /> 5_,25---/9 PERMIT �,`/� 0 \ _D(04 <br /> Owner/Authorized A Agent Si natur Date Rev's 10/10/2018) <br /> I` <br /> g g ( t <br /> jbl i Atb WO o2� <br />