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ilMi PERMIT APPLICAT IS <br /> LI <br /> BUILDINCIt1VIECHANICAL I PLUMBING / SIGN-I-SPRINKLER I DEMOLITION <br /> EVERETTCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PR JECT SITEINFOR ATION <br /> PROJECT SITE ADDRESS: t 1/G1/' f/.1th/ 9r1'vei iliei PROPERTY TAX#: 0(67/70CD,0070 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ikJ'-�( A y/ ( 1?efiti� TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 7/1/(JU ,Orr/L"e/ <br /> CITY til STATEr ZIP <br /> i � ' <br /> OWNER PHONE: s 3.2/, _ 3 OWNER EMAIL fi-/( ' � <br /> . .„,_, ,„ „.,. .,„,,„„„,„ ,, <br /> CONTRACTOR NAME: i v ti <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICEN E#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: eiSifyi ( t ri5ir/'�cf,/ CONTACT PHONE: 4'25l32?-C /) <br /> CONTACT EMAIL: f r " r ii fir,•o ,(,eyr, <br /> BUILDING INFORMATION // <br /> Existing Use of Building: �.GC!/(WI II, ,/J(A�J'^ i Contract Price of Work: $__/ `f <br /> Proposed Use of Building: SA ✓r-t Heat Source: , Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse 0 Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: 1:1 New DAddition ❑Remodel ❑Repair ❑T.I. OSign Sprinkler El Demolition OChange of Use <br /> DESCRIPTION OF WORK: c7o / 6(/f^ <br /> �`l��i'I� 1/r/�(�L�C�1/^�� J_'>I�G/ r�,��' Ir�,k�lf�ffi ��L�`� t <br /> .Aciffi�� 6 M.4-- o J1/(1'96111 <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 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/InserULog 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 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> (%f (--Y715'- '1:77/A/ —5Igo-7 - Oto <br /> Owner/Auth rized Agent Signature ate (Revised 4/15/2019) lb::` <br />