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PERMIT APPLICATION <br /> BUILDINC_IIECHANICAL I PLUMBING/SIGN RINKLER/DEMOLITION <br /> EVERETTCiTY 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 1 www.everettwa.gov/permits <br /> (Blue or Black ink Only Please):. _ PROJECT SITE:INFORMATION <br /> PROJECT SITE ADDRESS: a ri- `V a ttra P1.S L e v erre 1 W Pt PROPERTY TAX#: Q Q 3 j(.8--(017.-(301-(D <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: q- <j cp TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET C,i 7-6 \ F1 SS <br /> p a O p CITY �jJ exe- STATE (,.S A ZIP Rr <br /> OWNER PHONE: O 6 1 a, 0-3(p OWNER EMAIL: e (Nct r car t mol to �Meu\.c <br /> CONTRACTOR NAME: OW f)e_ir- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAiL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: r CONTACT PHONE: _$1a�_n3(0 (c, <br /> Wa a TPS CONTACT EMAIL: 0." B� Lio_("rem x� l M- <br /> / <br /> :.- • BUILDING INFORMATION . <br /> Existing Use of Building: Re g t� � � Contract Price of Work:$ ekS _ <br /> Proposed Use of Building: .SAI`[ _\ Heat Source: ti)Gas DElectric ❑Other <br /> BUILDING USE: ❑SFR DTownhouse 2iDuplex QADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project ❑New DAddition ❑Remodel ❑Repair DT.I. DSign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ipcirka (.10,\:\ CX(t A sfi&©c k.0-1 o TIDO Iv\`\ I `�� kcook <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIOi <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures coupe 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,ftoor) <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 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 I_SUPPRES SION SYSTEM Sewage Ejector or Sump Pump Other. <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads. <br /> ACKNOWLEDGEMENT: 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,stale,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.umstance.lam the owner,or 1 am authorized by the owner of this property to perform the Work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.2OOA WAC. <br /> City of Everett Official Use Only <br /> r '� PERMIT# . r <br /> Owner/Authorized Agent Signature Date (Revised 4115/2019) <br /> z 11 <br />