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PERMIT APFLOCAT9Ou <br /> BU LD NG I IlillECHANICCAL I PLU)jv/I 3)NG I SIGN / SPRINKLER I DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ;> 1 t 1 \ t...);-�- PROPERTY TAX# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: POO 1G=L. L v % < 00 / TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET ?. 0 . -j 0". GCS <br /> CITY C vc.cre-t STATE ZIP <br /> OWNER PHONE: 1. �_ ( '�' OWNER EMAIL: '^"' ' ' '` '14.e!' 1 . CC_M <br /> CONTRACTOR NAME: c-j u-9t`�1,0" <br /> CONTRACTOR ADDRESS: STREET <br /> CITY /(7 ( STATE ZIP <br /> CONTRACTOR PHONE: 7e, G 7 t'Z 7,4-2 P,` CONTRACTOR EMAIL: I <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) �i <br /> CONTACT NAME: v oo 16:....6._ w y k' t cs►,y CONTACT PHONE: LOQ :- ZO- 24 <br /> CONTACT EMAIL: )4H;21 Cif,, �, ctt , L <br /> BUILDING INFORMATION <br /> Existing Use of Building: >H � <br /> Contract Price of Work:$ 11P ..t 000/ <br /> Proposed Use of Building: �4/*f. Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ESFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New EAddition ❑Remodel ❑Repair DTI. ❑Sign ESprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Qepkr 5;,.4.c�kes o- -t. Ot>k{. is- moose_ JQe ra <br /> th,72-A S v., A a.•tea , <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 SystemNo.of Heads <br /> Chemical Suppression System I INo.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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> --)d;r:c_,--,e / City of Everett Official Use Only <br /> / 1'/7w n��07 q 6r�• PERMIT\ lO�+- ��� <br /> Owner/Authorized Agent Signatut,= '"` (� Date L (Revised 4/15/2019) 117 <br />