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PERMIT APPLICAT1016 <br /> #.,-1 BUILDING-ECHANICAL/PLUMBING/SIGN RINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> y 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 /> (Blue or Black Ink Ont/Please); PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Li(0 7-0 Suz 4 l evisyz.gvr g5V3'PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ..-1/4,14-,S7-r-, 4 Oa" G1 t I-4-t TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 41020 <br /> 4pc ' Pro <br /> �-! p� <br /> CITY `+J`' 9--e,r�' STATE �`"r' ZIP R.C52.0; <br /> OWNER PHONE: 44:2--`-j. -1 o" it-tqc,e, OWNER EMAIL: y S 1t c? Gall-fie C-9KA^ <br /> CONTRACTOR NAME: - OtAlts3€442.J. <br /> CONTRACTOR ADDRESS: STREET <br /> I - - <br /> CITY STATE ZIP C <br /> CONTRACTOR PHONE: ` - CONTRACTOR EMAIL: _ <br /> CONTRACTOR LICENSE#( (2UIRED): _ 3USINESS LICENSE#(REQUI ): <br /> PRIMARY CONTACT: OWNER ,1,._DNTRACTOR ❑OTHER(Please Specify) ---/ <br /> CONTACT NAME: CONTACT PHONE: ' - - j <br /> CONTACT EMAIL <br /> BUILDING INFORMATION �Y �r <br /> Existing Use of Building: 2.Contract Price of Work:$ { -' -w` <br /> Proposed Use of Building: Dt.gj) L.Pcv-4.1 ,2 tI9 pJz-45T eat Source: OGas ❑Electric DOther <br /> BUILDING USE: EfgFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ONew DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign WriSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> V ( ►`1 4 cu-t--3 V-t- ,`•t" ..1-1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> FixtureList of Fixtures urtica List of Fixtures Fixture List of Fixtures Fixture List of Fixtures <br /> Count count Count Count <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_jeater <br /> SPRINKLER 1 SUPPRESSION SYSTEM Sewage Ejector or Sump Pump ( Other:jJ'5Q(ZEN ILLela-- <br /> Water Suppression SystemI No.of Heads 47%-cs TA- --��pev.pi•.oW <br /> Chemical Suppression System No.of Heads <br /> ` <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 t 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 296.200A WAC. <br /> City of Everett Official Use Only <br /> 96 (fl #PET ,c,tct 00Z <br /> 0 riAuthorized Agent Signature Date (Revised 10/10/2018) <br />