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mil PERMIT APPLICATI <br /> BUILDIN JIECHANICAL/ PLUMBING/SIG RINKLER/ DEMOLITION <br /> E V E R E T TCITY 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 /> (BRlue,or Black Ink,Only,Please) .._ ..,. , PROP, ECT SITE INFORMATIION *,u ,_ . <br /> PROJECT SITE ADDRESS: \\ ` "P PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ,CONTACT INFORMATION. , <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): tiVrokinda. bet,0( c <br /> OWNER MAILING ADDRESS: STREET L. '�5 \ <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:14-- 1"Cro � _&l DA <br /> CONTRACTOR ADDRESS: STREET f V `� l3 <br /> CITY ,\/ (.J( STATE U3 l ' ZIP 2,0 ce <br /> CONTRACTOR PHONE:(1cZY) 22_9 -- cs- 72._ CONTRACTOR EMAIL: a u(cth )AC C„.V)--- -f t r C oto 1,c'Al <br /> CONTRACTOR LICENSE#(REQUIRED):?! l. it i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Speci ) lM C r a pk. _ 3l j <br /> CONTACT NAME: CONTACT PHONE: 1125 (09 - go cto <br /> kA(A.A IL ct c 6 L1 f CONTACT EMAIL: <br /> Existing Use of Building: Contract Price of Work:$ p r <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: CI New ❑Addition ❑Remodel ,Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: • <br /> C•f n ‘C- ,‘\r t • n .r- C( gU vv r51�n S 6n n <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPl1,CAltION .... .,.. . 6: :. PLUM BiNG PERM IT APPLICATIONR.,.,.. ''' <br /> Fixture Fixture 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 Ventilatior 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 /> 4 SPRINKLER/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 authofized under any circumstance.lam the owner,or lam 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 <br /> 2q PERMI� 1.� O L1 ,©t <br /> 0 r/Authorized Agent Signature Da (Revised 4/15/2019) 0 <br />