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s PERMIT APPLICATIO< <br /> al <br /> BUILDING I MECHANICAL/ PLUMBING /SIGN /SPRINKLER I 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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 'Q 1 1 - Fue-T-- n tau. , PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision 1 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): V € 1I L'&\( V\ <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: C. ( T \ N t 11,m6 in <br /> CONTRACTOR ADDRESS: STREET P()R bli\ t L) <br /> CITY 16Q`t-hP.11 STATE L ZIP6tgO4'1 <br /> CONTRACTOR PHONE: `"I J -5h q ---1(z,61-1- CONTRACTOR EMAIL: C140 be y Llmo. Cr)(Y\ <br /> CONTRACTOR LICENSE#(REQUIRED):[.Rp u. **1.4.8.3-1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):1 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) U <br /> CONTACT NAME: CONTACT PHONE: <br /> lbW\ -13`t/1 / CONTACT EMAIL: <br /> 1 BUILDING INFORMATION <br /> ° <br /> Existing Use of Building: Contract Price of Work:$ D.d <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse 0 Duplex DADU 0 Multi-Family-#Units: V1Commercial DAccessory Structure <br /> Type of Project: ONew ❑Addition DRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 1VLAY fi x4)/tc \\I 007/0901(0( <br /> ASSOCIATED BUILDING PERMIT#(if applicable): -1,3 Rog <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) ,r.- Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer / ,� link-Residential <br /> ink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher (` (kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation ! Floor Drain e Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb 1 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 /> 0 <br /> City of Everett Official Use Only—017(iLl <br /> I 1 7 (ig PERMIT t/] 6'5r 601 <br /> Owner/Authorized Age t Signature ate (Revised 4/15/2019) <br />