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0417 PERMIT APPLICATIOV"r
<br /> BUILDINCECHANICAL/PLUMBING/SIGN I'I'FRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (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: ,s 0 J O H rivtizo.:TV ki A PROPERTY TAX#:
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<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: VA AA A CA/WC. , gp'j iv CArafiNANT BUSINESS NAME(Commeraial):JhelinkCt ,.M C ay
<br /> OWNER MAILING ADDRESS: STREET 2,8-0 I ®�.l E Ave,-- l VI `lei-717-� l ci1"L/'VPm4?
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<br /> CITY id,,,,."kii STATE '6'vy ZIP
<br /> OWNER PHONE:�`si 0 OWNER EMAIL:
<br /> CONTRACTOR NAME: -3-0 1.-}4,JS00 L. \nb.
<br /> CONTRACTOR ADDRESS: STREET `SLI-' 21 .- ,, j, ,577/-
<br /> CITY #"iv `1 in 11,4 -' STATE WI"" ZIP 9?CD-24
<br /> CONTRACTOR PHONE( V i) ?3& CONTRACTOR EMAIL: 6(,),, a, r tAr, ;,. , -.1,
<br /> CONTRACTOR LICENSE#(REQUIR ): J b14 S G* 27-11-CAL__ CITY OF EVERETT BUSINESS LICENSE#(REQUIRE : 2.51g8c1
<br /> PRIMARY CONTACT: 0 OWNER y CONTRACTOR 0 OTHER(Please Specify) A LID c by 0 �J2Q�
<br /> CONTACT NAME: CONTACT PHONE:( ( ) 3 c — `
<br /> K CONTACT EMAIL: 13 I21 fi.rs a r CD 141
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: ' ` a/4 Alpe,L Contract Price of Work:$ 6Ojoa,9
<br /> Pro•osed Use of Buildin• Heat Source: Gas tric ❑O
<br /> BUILDING USE: lie^ % ;se plex FaI: 1mfhrinkler
<br /> •w ■model pair ■. molition ange of Use
<br /> DESCRIPTION OF WORK:
<br /> genii Vat a9-" moi/ bot /ee GZdt.01 /n5ii-iffz-hoA- 0C II/''e co K llle"e- 60/% r:
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> FixtureFixture 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 /> 1 Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar)
<br /> f 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 /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System I No.of Heads
<br /> ACKNOWLEDGEMENT:!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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comp/ with the State Contractors Law 18.27- - and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> „.,_, ,,,,---/-: / i ' 2',
<br /> /9 PERMIT C
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<br /> O erM ithorized Agent Sign a Date (Revised 10/10/2018)
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