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1.11 PERMIT APPLICATION
<br /> BUILDINC�ECHANICAL I PLUMBING /SIGN II RINKLER I DEMOLITION
<br /> EVERETTCITY 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 I www.everettwa.gov/permits
<br /> (Wile,or Biack,Irik 0i4 Pieiee) t.<.s.:A s PROJECT S17`B$NROIINJATIO,R=,- , ..,�x rR, y; .,5,.,.,,,, , ,, ,.,, ,.,
<br /> PROJECT SITE ADDRESS: 0 5 O ( las / UAB PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> 1EPE .... „ a a.. 0010 AC111+I1=0RMA?10 li 5
<br /> OWNER NAME: x TENANT¢ BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET // "-V _ ,. 1 / ��
<br /> CITY �ij 3 tAl2 '______VVV�����"' STATE v*✓�' ZIP 9 g--7-41
<br /> OWNER PHONE: it.1$�-'3 03-- f WO 3 OWNER EMAIL: /JfLC/C1,GTY)t t �s
<br /> u �`'s,�r�t
<br /> _.q
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET
<br /> STATE ZIP
<br /> CONTRACTOR PH•• : C• ' -, - •R EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT:XOWNER ❑CONTRACTOR 1. OTH /J ' 'ER(Please Specify) r T!'�� 1
<br /> CONTACT NAME: /\\ CONTACT PHONE: Liz 2 5" - so 3 --7S.0 2
<br /> CONTACT EMAIL: /9 cq 46 0 ersmojzr„tit
<br /> ;.,, y „ . BUILDING INFORMA1ION „ 'il ., . g N=.r_. g , . I „ a
<br /> Existing Use of Building: A- ./ Contract Price of Work:$ .$-e10. -6 a,0 a
<br /> Proposed Use of Building: /,t i u Heat Source: Gas ❑Electric ❑Other
<br /> BUILDING USE: /ISFR ❑Townhouse ❑Duplex ❑ADU 0 Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition l]Remodel El Repair ❑T.I. El Sign El Sprinkler El Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:` v �•
<br /> e1 .�
<br /> 3 If o.30
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHAMICS,k,L;;PERMilt40410:1�1#00 *:,L- M .B.INOZ , ;PPUC,TIOR..
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Count • Li of Fixtures Count List of Fixtures Count List of Fixtures
<br /> -Air Handling Units :s Piping Backflow Preventer(I side Bldg) Showe ub,or Combo
<br /> Boi• Gas Range Clothes Washer Si• -Commercial(3-comp,prep,floor)
<br /> Clothes n t er Heat Pump&Ductless Dishwasher ink-Residential(kitchen,bath,bar)
<br /> Duct System remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Re '•-nti- Commercial Ventilation Floor Drain Toilet
<br /> Exhaust Hood(Type I (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Ty,• II) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood 'residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air stems Other: Medical Gas Water Valves or Fixtures
<br /> Gas.Fir=.ace/Insert/Log Roof Drai Water Heater
<br /> SP„ ,LER 1, rPPRESSIO$_ w YDS,.TENT, Sewage Ejector or Sump Pump Other:
<br /> Water Suppression S No. • Heads
<br /> Chemical Suppressio ys No.of Heads.
<br /> ACKNOWLEDGE NT 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
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<br /> --- f PE ”` 023
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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