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PERMIT APPLICA • <br /> BUILDINWIIIECIHANICAL/PLUMBING/.11M PRINKLER/DEMOLITION <br /> Oi#01111//S":"4- <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 /> ( or`Black Ink Only Pie...) PROJECT SITE I ORMATION <br /> PROJECT SITE ADDRESS: : 112 'PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 'r n TENANT BUSINESS NAME(Commercial): my 01,1),4._ <br /> OWNER MAILING ADDRESS: STREET D3- 1`r • fir t Av° 1: P <br /> CRY 1.�� _ i STATE _' ZIP 782-0 J 1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: +e �S <br /> CONTRACTOR ADDRESS: STREET 9.,,,,6, 1469f ?9 T'A <br /> CITY L.. STATE i ZIP (g Q g� <br /> VV <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): .r!lt-i1.► al_ P CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): i <br /> PRIMARY CONTACT: 0 OWNER ► CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: —273 — GO Z. <br /> (Ta el61e•,s payk___, CONTACT EMAIL: • ., t• <br /> 1 i . iilFi iii i I i I i i mi�u iiuwl <br /> BUILDING INFORMATION " r <br /> Existing Use of Building: Contract Price of Work:;,....ia,412,, <br /> Proposed Use of Buildin.: Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR DTownhouse DDu•lex DADU DMuiti-Famil - • Units: I'Commercial DAccesso Structure <br /> Type of Project: ONew DAddition DRemodel El Repair DT.I. P ign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 7n S–f t I( CJ re 11-,1 ay) 1k is II <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fbctun) Fbuure Fixture Fixture <br /> Count List of Fixtures count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC-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 /> SPRINKLER I 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.lam the owner,ori 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 /> NO City of Everett Official Use Only <br /> C -/--,k PERMIT ® <br /> Ct- <br /> Owner/Authorized Agent t Signature Date (Revised 10/10/2018) <br /> 1 <br /> 2- <br />