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II II ''II PERMIT APPLICATION•
<br /> BUILDING'TMECHANICAL/ PLUMBING I SIGN J SPRINKLER/ 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 1 www.everettwa.gov/permits
<br /> (Blue,ar`Black ink O my Please]: ...,, .. P,HOJECcT iITE INFORM iTION. .s., .. ,.., ..3 ...., ,.r. ; .,,o,.a
<br /> PROJECT SITE ADDRESS: j 1).6-- 04 k5 /tie gicil PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision J Lot No. (attach copy of long legal description)
<br /> ` _ _> 4 � 5
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<br /> OWNER NAME: H u5i yti fleitk, TENANT BUSINESS NAME(Commercial):®z LQ{ti fMQi.A5
<br /> OWNER MAILING ADDRESS: STREET c'et43O Ifif/Gr9rte ,, �,, /pAY
<br /> CITY i it 4, if / STATE /jet ZIP 9/2.03OWNER PHONE: OWNER EMAIL: 1
<br /> CONTRACTOR NAME: Ai I led c..6,,,-i-j'u1ii'l;:. 4450c, AC_
<br /> CONTRACTOR ADDRESS: STREET 1 14-e iji t.
<br /> CITY E 0 r .J`p (1 STATE ti 1 i ZIP c q�I
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<br /> CONTRACTOR PHONE: e42_6--- Z, 9 - ipQS"] CONTRACTOR EMAIL: 1461£j j r Ilg0 Qlt,�ed cmAciYt9GJrde4, n1
<br /> CONTRACTOR LICENSE#(REQUIRED): ;LL_x.Ejpr CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ''',._,:,:,..k. .
<br /> PRIMARY CONTACT: ❑OWNER tit CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: qZ5"— '7Na 14411 3
<br /> ...);11 Su1 a 1/150 r\ CONTACT EMAIL: k95& a✓I Sokx .et/f J cAhcfleii aidst. ""I
<br /> BUILDING,INPQRMA1TIO .
<br /> Existing Use of Building: idG9 ttiLCQ04C.-- &CO yt77 Contract Price of Work:$ lopro
<br /> Proposed Use of Building: 6/4/l}- Heat Heat Source: ❑Gas AElectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: t 0 ❑Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.1. OSign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ,u,,,,.cw.e 04,101 repiacc. het fL e -,,,,t ex 1,01)5I.- . r*it e l i�i-1 13a� `41+
<br /> 14:4 I�,�, 1 i tilAksrh�. 1 ki S1(4fid--) re.- ;e14-14e �4e � d rskt,.1a4 Il+tii nzt,J au-,v, „
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): (jivy/ -02,4,
<br /> OM MECHANICAL PERMIT 4ouoittowew. x._ ,. 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) U(') Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless i0 Dishwasher ),Q Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> tO Exhaust Fans(Residential) Commercial Ventilation Floor Drain 10 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 /> t0 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,I„SUPPRESSION SYSTEIIJC ? 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 /> 0104;,0,1 /4 yta,,,,_ . tt - -7 - t 1 -`1, 11 1 i - Ce(3
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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