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= PERMIT APPLICATIHI <br /> vs <br /> BUILDIPI.II I MECHANICAL/ PLUMBING/SIGI tPRINKLER/ DEMOLITION <br /> EVERETTCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue+fir Black Ink,Qnly,I teasej..t...... ..PRO ECT SITE NII_;?ORMATtl(. .,.;e s <br /> PROJECT SITE ADDRESS: '.... "-3 t ( I=S'CJ 4\1 _,_ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> TACT,rIN 1.ORMA ,Ois r <br /> OWNER NAME: 5e 3 \..) ;1'1,.., 1c9. TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 33l `7 C__„>~ A oJse___ G� <br /> CITYu"P-feria t STATE L- A ZIP f DG�C 1 <br /> 1 <br /> OWNER PHONE: 2-S`3� 6^7Z14� OWNER EMAIL: _ Ul(1(.. —_,thilL.1c; I-C—© °I'-' <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> _ , � ...2 • �.� <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> `,BUIL©SIG N00RM',AT , <br /> a_� <br /> Existing Use of Building: 4,p_,.0) Contract Price of Work:$ _T0 0 co <br /> Proposed Use of Building: be w...p Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ...MECHANICALSPER:1040.LICATION < '. ., .. . <br /> MPLUIVIBtNfi�-P#M011'I`0RLiCA'T'yONK. :-..: <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 /> BRRINKLERJ OUPARESSON70$#SPIER 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 D 11 V(v., l0� <br /> L- 1?)- — 1 <br /> Owner/ Drize ?ftPtiZlq4 <br /> Date (Revised 4/15/2019) <br />