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PERMIT APPLICATION <br /> in BUILDING/MECHANICAL I PLUMBING/SIGN !SPRINKLER/DEMOLITION <br /> EVERETT T T CITY OF EVERETT PERMIT SERVICES <br /> K 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) ff PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 32.2.1 }`t o y r A Vim—(P� PROPERTY TAX#; , <br /> LEGAL for new construction: Short Plat/subdivision 1 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1410 a,}"'[+./ rt.4z-re.84 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET '. .---1)M-e ---CL <br /> `'`J-.2�j-k T Ate'' /� <br /> CITY .. 1t-e { �STATE '( A ZIP If Z 1 <br /> OWNER PHONE: 147.2s) 3ZO`" gq(-y- OWNER EMAIL; <br /> CONTRACTOR NAME: 9. i v+ ( — >4 el <br /> CONTRACTOR ADDRESS: STREET 2-I'LC) 'N,k}c._,:{Le-- <br /> CnY li'V�/�T rr STATE npltrlert <br /> CONTRACTOR PHONE:(it'ZSI Z$Z—3 I I i'— CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):f,��,/g7 ,5 -"L..,Cr - CITY OF EVERETT BUSINESS LICENSE#(REt1UIRED): 17 ,55- <br /> PRIMARY CONTACT: ©OWNER la CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME CONTACT PHONE: (r f Z$) fpr'-- 07 Z <br /> 1t- 3A-1-0 CONTACT EMAIL: 1 n e Sol..cwcc I C <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 2 7 5-0 <br /> Proposed Use of Building: Heat Source: Pas DElectric DOther <br /> BUILDING USE:OFR ©Townhouse ODuplex DADu DMuiti-Family-#Units: ©Commercial DAccbssory Structure <br /> Type of Project: [New DAddition ORemodel taZepair OT.I. OSign OSprinkler ['Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# if a.•iicable: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> FixtureFixture <br /> List of Fixtures List of Fixtures List of Fixtures Fixture <br /> irxrun List of Fixtures <br /> Count count Count Count <br /> NC—Air Handling Units Gas Piping t 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 Ventlaatior Floor Drain _ Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb ,Urinal <br /> Exhaust Hood Mips II) Water Heater Interceptor-Grease WasteNVater Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/01i 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 /> 1 <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: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 willing from the <br /> Building Official before being authorized under any circumstance.!am the owner,or l ern authorized by the owner of this property to perform the work for which application is made, <br /> and f comply with the Slate Contractors Law 18.27 RCW and 296.2004 WAC. Chir of Everett Official Use Only <br /> PERMITlot 10 -21- 1� D - ?� <br /> � <br /> Owner/Autho zed Agent Signature Date (Revised 10/10/2018) <br />