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477- PERMIT APPLICATION <br /> BUILDING ECHANICAL/ PLUMBING / SIGN V•• 2INKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201X 42 <br /> (P)425-257-8810 I FAX I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> fl g <br /> PROJECT SITE ADDRESS: 'Z2I?)46pd A\/ y k£, PROPERTY TAX#:0059 tC)00 �,3 CY) <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): <br /> OWNER MAILING ADDRESS: STREET 222 --kIG� c..9I61Vt c6Wnut•e <br /> ` -ert 1 . CITY Ev i JJ STATE VSI A ZIP 9?2O1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: —1Y1S-kG't gC.kkc()Yl ►JNi OIJoYLQl. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT:X OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> t%ProExisting Use of Building: Contract Price of Work: $ I i:3-06, 1).(--)- <br /> Proposed <br /> posed Use of Building: Heat Source: giGas ZElectric DOther <br /> BUILDING USE:I,SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: J,New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> . -Y15*411cc.-i- \ of sacs P)‘p>in fYoPn PSf- m3•-Hem is L4 {,xku .s - v ►s no-�1_ an <br /> -e.Xist1Y1 As QNLQ. in -flta. h�, -this u l biz C• ►vi.uJ 9in5L . 1S*GUUEr WS1� `0-2 I'lovvlQ Qr <br /> 11�}}�� a�s a�cstfr�jw\ c r2-$ire c.Q a�uAYVII�R,� �;'1� 4exP2r-ier1CQ IrlS1c\\,v-C, licks �;(I'l C . <br /> ASSOCIATED UILDING PERMIT#(if applicable): c3 <br /> CAS <br /> 1 MECHANICAL PERMIT APPLICATION Fixture PLUMBING PERMIT APPLICATION I <br /> 1 " "t I List of Fixtures I �fwiQ`& I List of Fixtures List of Fixtures I Fixture I List of Fix:u;is <br /> Count Count Count Count <br /> A/C—Air Handling Units I 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 Ventilatio 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> , 62- /9 -2or9 PERMIT11.#1I��0i0�l il <br /> Owner/Authorize em Signature Date (Revised 10//10/2018) <br />