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INN PERMIT APPLICATIOM <br /> LIII <br /> BUILDING/MECHANICAL/ PLUMBING 1 SIGN /SPRINKLER/DEMOLITION <br /> EVERETTCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 88201 <br /> WASHINGTON (P)425-257-8810 I FAX 426-267-8857 I(E)everetteps@everettwa.gov I www.everettwagovtpermits <br /> (Ohm or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 s-2,7 IL c(2.el.z,_ "cis- [PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of tong legal description) • <br /> CONTACT INFORMATION .. <br /> OWNER NAME: 6443 .Lzi- war g Q ix //Pi7e5 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: smear <br /> MY STATE ZIP <br /> OWNER PHONE: (421,,),i,35-47-7g 7 'OWNER EMAIL: <br /> CONTRACTOR NAME: 7-:;/e120,24..cP1) t_cy .77 NAZI-7- if 46 <br /> CONTRACTOR ADDRESS: maser '' .i <br /> CM' r.--,Ltk-Crr- srAm ILIA . zip 41f243/ <br /> CONTRACTOR PHONEf4761 •Z.52—0/i 9 CONTRACTOR EMAIL: ke kt.a) 4e 5' n.-t t..-€'11 cot . <br /> CONTRACTOR LICENSE#(REQUIRED): _CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): 0-101, s- <br /> PRIMARY CONTACT: 0 OWNER VCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:( ..zs.:5 ,5D .-87 2-1— <br /> KC-10 CONTACT EMAIL: K.4. <br /> BUILDING INFORMATION <br /> 00 <br /> Existing Use of Building: Contract Price of Work:$___.„,412&-- <br /> Proposed Use of Building: Heat Source: &Cas EiElectric DOther <br /> BUILDING USE: EISFR OTownhouse ODuplex OADU OMulti-Family-it Units: OCommerclal OAccessonj Structure <br /> Type of Project: ONew DAddition ORemodel DRepair OT.I. Osign OSprinkier ODemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> Rpk-(6,7. EV(51-7 (o &O.•EZ2N4.-CQ ilive-4.)--. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Mum Future Fixture Fixture <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Count count Count , Count <br /> . , <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(kttchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) 'Commerclal VentUatior Floor Drain Toilet <br /> Exhaust Hood(Type I) SNot Heat/AC system)_. Hose Bibb Urinal <br /> Exhaust Hood(Type II) <br /> -1Witter Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove interceptor-Sand/Oil Water Service(behind meter) <br /> •X Forced Air Systems Other Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> -....1 <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System I No.oll-feads <br /> Chemical Suppression System I No.of Heads <br /> . . . <br /> ACKNOWLEDGEMENT:I have reviewed this application end 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 end no deviations therefrom.Deviations must first be authorized hr 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 perfomn the work for which application Is made, <br /> and I comply with the State Contractors Law/8.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> , ) z <br /> PERM <br /> lt___ IP I pato <br /> Owner/Authorized Agent S.gnature Date (Revised 10/1eao e) <br />