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• <br /> PERMIT APPLICATION", <br /> "111 --A4BUILDINECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> y 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blur or Block Ink Out/Moose) PROJECT <br /> t� <br /> PROJECT SITE ADDRESS: 102 4 6E- U:ef -t M&U 1AJW / 4 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:�T�hhill L0-1-I' Cj blown, TENANT BUSINESS NAME(Commercial): fbPo e'j LL-h.4 <br /> OWNER MAILING ADDRESS: STREET I nu 66 Et.iQA it IUQI , 1A j4, , # e <br /> CITY E Ip irset- STATE i - ZIP g g <br /> OWNER PHONE: )4 5 ota 011151.17,5,jVl02s-,265qaJ WNER EMAIL: <br /> CONTRACTOR NAME: ..6A awn 4 pp,)(Lr <br /> CONTRACTOR ADDRESS: STREET • • c Fj�j f}V� 6E <br /> CITY r otApja STATE A ZIP C)k0 <br /> CONTRACTOR PHONE: J4025- � - 0e2-4-3- ICONT' 'CTOR EMAIL: °pi erica, g ci o i • corn <br /> CONTRACTOR LICENSE#(REQUIR. ir): 4 Pew e6Ni q 05 Lel CITY OF EVERETT BUSINESS LICENSE#(REQU D): , R-ZN6( <br /> PRIMARY CONTACT: ❑OWNER 13 CONTRACTOR Al/OTHER('ease Specify)_ hO it7LG a /- <br /> CONTACT NAME: CONT CT PHONE: doh j4, 5gCi(q <br /> SCI Q- CO ACT EMAIL: ><A/,Ten LI e MO- I • G®'rn <br /> BU B ING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 2400 <br /> Proposed Use of Building: Heat Source: CIGas lectric DOther <br /> BUILDING USE: DSFR °Townhouse °Duplex DADU °Multi-Family-#Units: 34ommercial °Accessory Structure <br /> Type of Project::New °Addition °Remodel ❑Repair DT.I. Xsign °Sprinkler °Demolition °Change of Use <br /> DESCRIPTION OF WORK: -i-Q,.ee„ ono_ C i) A,L+ 0 S 1 11 aajainit '-4p '\rUJ-r)e .6.+Jam • F(brnAL <br /> +,ern >h Qx+'sf . 41-r wi bQ .>✓l.�tm;nccf i 'n_ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Rai" Rxture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures CountList 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 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 WastelWater 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 I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System of Heads <br /> Chemical Suppression System ( No.of Heads <br /> ACKNOWLEDGEMENT*I have reviewed this application end confirm the information contained herein is true end correct.Work done pursuant to this permit must comply with <br /> current federal,state,end local law.The granting of a permit only authorizes approved work end 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/am authorized by the owner of this properly 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 /> 1/ I 12.01°1 PERMI r cos <br /> Owner/Au orized ent Signature Date (Revised 10/10/2018) 1 <br />