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IIM PERMIT APPLICATIaI. <br /> ini, <br /> BUILDININVIECHANICAL/ PLUMBING /SIGIJ I OPRINKLER I 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 Blackiflk O)iIy Please).,:: ,. .. ..s ,..PRO, EGTSSITE_INFO MATION.....E .. , ..,...., E. .. <br /> PROJECT SITE ADDRESS: L,5-Q --)S.3I 64 �L.t) Su14-e__ /al) PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ; CONTACT iRFORMATIOI <br /> OWNER NAME: hh�o,A Pro( <e5 I 1....LC— TENANT BUSINESS NAME(Commercial):f, ,S[.4 de Cjcree <br /> OWNER MAILING ADDRESS: STREET P 0, _ a B <br /> CITY rJt/.U.b STATE/41/4 ZIP 93a o4 <br /> OWNER PHONE:`OS- I R-l4 ,1 nn <br /> J OWNER EMAIL: (oTr- QJ 1' . 44m. <br /> CONTRACTOR NAME: pti,n,GJA 14DVA{S L Prap - e5 <br /> CONTRACTOR ADDRESS: STREET fi Q, fp_x_ /3085- <br /> CITY Z N'e-rtA STATE 0 /1 ZIP . .?„q ec, <br /> CONTRACTOR PHONE: S" —i-no e E C NT- ' c OR EMAIL:.3 '317 0 ""Fj,p, (2V1') <br /> CONTRACTOR LICENSE#(REQUIR SSt/P 3 CL ! ITY OF EVERETT BUSINESS LICENSE#(REQ ED) t tW,.., <br /> PRIMARY CONTACT: 0 OWNER = •NT-_ •; ■ • (Please Specify) )'(et:. ' 0 7,1 <br /> CONTACT NAME: SL°•rr \‘.011,1 CONTACT PHONE: 4fS 87S.4(.'7 0 <br /> CONTACT EMAIL: ‘Se.aT (,ej <br /> .....BUILDIN0 .0.ORMA'17bN Y.,... <br /> Existing Use of Building: Prod'G'k v Contract Price of Work:$ ic2,009 <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: I Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel CI Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:�e ;r- *S.5 deGiVietjt <br /> dile <br /> 740 lgrk liAL <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APP LICA,TION, PLUM118iN r PERMIT.APPLICATIQN._= `` <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or r "io <br /> Boiler Gas Range Clothes Washer Sink-Com..- cial(3-comp,prep,floor) <br /> Clothes Dryer Heat Puy.::Ductless Dishwasher Si. 'esidential(kitchen,bath,bar) <br /> Duct System(Remodel) R- ` eration 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(Re ntial) Wood Stove Interceptor-Sand/0' Water Service(behind meter) <br /> Forced Air Sys - s Other: Medical Gas Water Valves or Fixtures <br /> Gas Firepl- -/Insert/Log Roof Dr.' ` Water Heater <br /> SPRIN ,..'tiklfSUPPRESSION 'SYSTEM, S- -ge Ejector or Sump Pump Other: <br /> Water Suppre .on 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 lam 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# ` \®9 U.,4 <br /> Ow . orize. -gent Signature Date (Revised 4/15/2019) <br /> 0 <br />