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'TMII��� PERMIT APPLICATI
<br /> BUILDING1MECHANICAL/ PLUMBING /SIGNT PRINKLER/ DEMOLITION
<br /> E V E R E T TCITY 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 1 www.everettwa.gov/permits
<br /> (Bele or BlaI k,Ink,Only Please`,,;.. . Ili .P(001 SITE*t:Elik0*M*ttp*aEtkVettekEiRZREMNVVFWk.
<br /> PROJECT SITE ADDRESS: . ....5".1r.- /')/7 Alit PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> _.,_... ._ w:-CflIN1TAGTtiNF©Rlit(4110M ,...... :.. .,,. . _ s.., . , '
<br /> OWNER NAME: TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
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<br /> OWNER PHONE: (OWNER EMAIL:
<br /> CONTRACTOR NAME: CO/Vat 7 J5j1/LO,M r 6—&vP
<br /> CONTRACTOR ADDRESS: STREET j 6„2-7 2p6, *`' 5'f- sL'/o /lox `/q 8r Love Treimif 0)- *25-9'
<br /> CIN gnieg,g___ STATE W/V— ZIP /Z
<br /> CONTRACTOR PHONE:,949( y-� tel 71., CONTRACTOR EMAIL: phi —gMiiet/rf a4,41.s 40' ,f<v2til
<br /> CONTRACTOR LICENSE#(REQUIRED): 6Q 2. R"3V CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)4iJ 19
<br /> PRIMARY CONTACT: ❑OWNER "CONTRACTOR 0 OTHER(Please Specify) ' f ' 1 IA�0
<br /> CONTACT NAME: yycON�BcR(�NI CONTACT PHONE: 26 9-6r- /170
<br /> PYhtil CONTACT EMAIL:
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<br /> .I.. „ , B.01.LDING IN ORMATIOW, ... u. i...j, , ,_ . , ,. . F
<br /> Existing Use of Building: e?r/li Contract Price of Work:$ ,000,
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: CI Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. El Sign El Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: itaw,- ✓39Tifi al
<br /> (ASSOCIATED BUILDING PERMIT#(if applicable): 17) 18 tO^D 0 t
<br /> :.MEDHAHICAL.I'ERMIT,AI"PUCATIONv , ., ,. .,PLIJMBING,PERMiT�APPLI
<br /> ,,. .. . CAT(©Irl<� ...;.. .
<br /> •
<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 \ Sin y6Qprnercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher I 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 t SUPPRESSION SYSTEnil 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.lam the owner,or lam 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 /> 4 / /, PERMIT /\ci 0,c3_ 003
<br /> caner/Authorized Agent •-gnature Date (Revised 4/15/2019)
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