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PERMIT APPLICATION =I''
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<br /> BUILDING MECHANICAL/ PLUMBING/SIGN I ISI-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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue+or Black Ink Oft Pleaset.sS._ .._. .PROJE T SITE.,1NF?ORMATION . .,.. .g... . ,v, , :... .._. ...
<br /> PROJECT SITE ADDRESS: 11 LT' QW f S hue_, 611 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision J Lot No. (attach copy of long legal description)
<br /> . . . CONTACT1P FORI1i ATION. .NMD
<br /> OWNER NAME: t' ju /i 14ip' TENANT BUSINESS NAME(Commercial): al k6 6/ yiiIi 5
<br /> OWNER MAILING ADDRESS STREET S"4'O Euej"9 fp�r1 way
<br /> .. CITY EteLif#i STATE 01 ZIP 1i ii
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: A-[ ed Coj' ' -cic+,0 45_504., Iry
<br /> CONTRACTOR ADDRESS: STREET ( 24 j4-p,j iF►T
<br /> CITY C �lll u-extTf STATE 01 ZIP 9$Z® 1
<br /> d—CONCONTRACTOR PHONE: 116-----_y 6() � 7 CONTRACTOR EMAIL: tri hie)/01 e. el/Wed omcireiciVot I Ad—
<br /> CONTRACTOR
<br /> TRACTOR LICENSE#(REQUIRED): i LL-1. ©Geg aJ9VERETTCITY ! BUSINESS LICENSE#(REQUIRED):d'57 b 1.72.—
<br /> PRIMARY
<br /> .ZPRIMARY CONTACT: 0 OWNER IE.CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ci�s-1 Lid Ill e.
<br /> W� .J
<br /> ff i I ( 1.3q�c3o 11 CONTACT EMAIL: 05F,��f Vl 53 M q II; ai,t(i✓}/P.' /ilfrh,
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<br /> , ,. , t , . , . ..., . . ` ,BUILDI G INFORMAL IO N.roh. ...'.. E ,
<br /> Existing Use of Building: i It
<br /> (�ketClm (400 ,`14i Contract Price of Work:$ qac
<br /> Proposed Use of Building: 7 Alt J Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: 9 ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel CI Repair ❑T.I. ❑Sign El Sprinkler CI Demolition OChange of Use
<br /> DESCRIPTION OF WORK: JZp l,..vrtrt 3 rep kcc, 6,44,‘( 90'1 px,tl tiS,(" PaA,4 f °`9e. _/ '-1 'hvd-/
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<br /> i &fftt nnul A k► 1.0 /�
<br /> 51"I , re.-Ir5 I( -eAt-:/;04,4 d►tsI- ww5tah4._ lel le
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): ts IO'T—0 2-s
<br /> MECHANICAL APERIYII' APPUC.ATIOR.,i . :; . .. .,i.,, P;LUMBiNO PERMIT APPLIRA7ION 3
<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) Li Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless L{ Dishwasher IS Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> if Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 9 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 /> HExhaust 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 /> SPRINKLERaI SUPPRESSION,S* TEM, ,,,„2 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!am authorized by the owner of this property to perform the work for which application is made,
<br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> (A)44.„ � PERMIT# ` \.f on4 m O n
<br /> Owner/ ized Agent Signature Date (Revised 4/15/2019)
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