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4177 PERMIT APPLICATIO <br /> BUILDIIMIMIECHANICAL/ PLUMBING /SIGN RINKLER/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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: JZ( - Ric- f-446", l OA ggyoj PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 41e4.11zY qND S,644vi is• tai,410,4 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 2.7.14 Kve.v-e1.. AVc <br /> CRY O- STATE 41/4 ZIP °I et,Zo I <br /> OWNER PHONE: (4i5) 2.12.-9493 OWNER EMAIL: j.at~cw4e»VI e..gw..,...11,ce,+c <br /> g Rn <br /> CONTRACTOR NAME: 64.4of,LI „ v0e5)-* 1; ► 1 11,G, <br /> CONTRACTOR ADDRESS: STREET 1 12&tO N6 11& ST l 4 mss{. <br /> WY loov113.91lLC STATE WA, ZIP 1$07z.. <br /> CONTRACTOR PHONE: (4Z5)1053-D CONTRACTOR EMAIL: tir'vssfiti@ wesi-Lt;ii i".Gowt -� <br /> CONTRACTOR LICENSE#(REQUI ). 0 1 iGi fi, CITY OF EVERETT BUSINESS LICENSE#(REQUI D): �19/5 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ®OTHER(Please Specify) ftp{rter-t- <br /> CONTACT NAME: CONTACT PHONE: (12.5) 251-D$(G,$ <br /> Amp ' 40.1,1-- CONTACT EMAIL: a,,,d y Q th Lr&It.coni <br /> BUILDING INFORMATION <br /> Existing Use of Building: M,,,,-rt-fat-•wY Nc..su.►c, Contract Price of Work:$ ac', o00 <br /> Proposed Use of Building: Mvt.rt- FAat1i r H.,,str-14. Heat Source: ,Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU 21Multi-Family-#Units: 3 ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition KRemodel DRepair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 4oi44et-4e4 cF A &vt.DPLE' ttCtn A -fR-1PLE .. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): "C.__e__. v E?"-A r, C- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture . Fixture Fixture - <br /> List of Fixtures List of Fixt <br /> Count Count List of Fixtures List of Fixtures C.-nt Count <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Z. Shower,Tub,o ombo <br /> Boiler Gas Range 1 Clothes Washer Sink-Corn.•--rcial(3-comp,prep,floor) <br /> / Clothes Dryer 1 Heat Pu •uctless 1 Dishwasher 5 Sink-* sidential(kitchen,bath,bar) <br /> Duct System(Remodel) 3 Re ',r=ation Drinking Fountain ' -'k-Utility,laundry,mop <br /> Exhaust Fans(Residential) !•mmercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) 1 Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residen Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air System , Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/• ert/LogRoof Drains l Water Heater <br /> _ <br /> SPRINK ' I SUPPRESSION SYSTEM _ Sewage - =ctor or Sump Pump Other: <br /> Water Suppressio• ystemNo.of Heads <br /> Chemical Sup•>-ssion System I INo.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.lam 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 O/fficiciall�Usse Only <br /> "...__,/ <br /> Owner/Ayj Agent Sig 44, Date (Revised 10)10/2018) <br /> Cl'i V) <br />