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I II I I PERMIT APPLICATIO1'I <br /> olgow BUILDINRTMECHANICAL/PLUMBING /SPRINKLER I DEMOLITION <br /> 1/�'! CITY OF EVERETT PERMI ES <br /> 411\ 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1/Or !/W ,G,1-e— PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (Q(N2 - TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET I(er) Ne4/11 ii it 41/e._-- //��, <br /> CITY , r- STATE t44+ ZIP s a v`0 <br /> OWNER PHONE: OWNER EMAIL: /')7 r$ ...../(21.A.-5 @ 0144/Erb 4 c 1.51/1--- <br /> CONTRACTOR NAME: Li (r„e. Q-i„,,3 <br /> CONTRACTOR ADDRESS: STREET /.----1/1 i7'v- q <br /> • <br /> fffI/1 <br /> CITY p 14/'r 1 4 STATE r�,'- ZIP(/o e? <br /> CONTRACTOR PHONE: C�' ='7 —t��`7 6 J CONTRACTOR EMAIL: f{rid 0 COLtcrte_c ns , yJ <br /> CONTRACTOR LICENSE#(REQUIRED): VUi-(1'7 4v 5]7 f LT CITY OF EVERETT BUSINESS LICENSE#(REQU ' ‘1 ®�w r) <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: n CONTACT PHONE: C 6.--.'0( CONTACT EMAIL: Thep p, 4wLi7te c i Fru c, we--t <br /> BUILDING INFORMATION <br /> Existing Use of Building: ?-1,5--F Contract Price of Work:$ 2—t l‘ '> <br /> Proposed Use of Building: `( Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: YeiCommercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ylSign El Sprinkler ❑Demolition El Change of Use <br /> • DESCRIPTION OF WORK: r pi S+ 6-1 411 kl 67Tip/1-1- - <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—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/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.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 R and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PE 9 # <br /> )/11)////, /4/ t 9 , ' _.03-0,4 <br /> Owner/Author ed Agent Signature Date(/ (Revised 10/10/2018) <br />