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EMI <br /> PERMIT APPLICATION <br /> BUILDING/11..1- IANICAL/PLUMBING/SIGN/SPRINER/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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE;INFORMATION . , <br /> PROJECT SITE ADDRESS:(p ) J Gill g sE PROPERTY TAX#: bt)q tobbo 9 3 A0be,o <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT°INFORMATIONM..,, .' „ ,. <br /> OWNER NAME: ChLtirlea► ?detrAele ( ly ty't TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET (pII 'd' Si Se- <br /> 1J7 <br /> CIN V -`/, e I f STATE 1,A)Pk" ZIP 063006 <br /> 06 <br /> OWNER PHONE: f ( (J1-+ OWNER EMAIL: <br /> CONTRACTOR NAME: 5 �[%iv t al c U� -3 D ho Lee- <br /> CONTRACTOR <br /> e CiCONTRACTOR ADDRESS: STREET I GJQD �, &)!& t Wa -11-1149'89 <br /> CITY V Wr +! V ,SSTATE r'f ZIP 3 3 <br /> CONTRACTOR PHONE: 31.00t p3 'CONTRACTOR EMAIL:j611 ej j(4-cer v cucik u <br /> CONTRACTOR LICENSE#(REQUIRED): SIT SsifiLtS ,, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: 0 OWNER ErCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME:`J\thy Lit CONTACT PHONE: 1..00 1Ptoi /43 cel t ` O ( 4 <br /> CONTACT EMAIL`Ibhne4 ,(i&cI CAA <br /> BUILIDING INPORM 4TION' 0._e ., .. .. <br /> Existing Use of Building:0,W Man*MIA ret,( t(Sm,e, Contract Price of Work:$ t 01 OO <br /> Proposed Use of Building: Y c1a6WI,CQ, Heat Source: ❑Gas DElectric ❑Other <br /> BUILDING USE: E1SFR ❑Townhouse ❑Duplex DADU DMulti-Family-#Units: DCommercial .❑Accessory Structure <br /> Type of Project: LGIIVew ❑Addition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: n I M , , f_G red how- placid 11r) 1A 4X <br /> v �n peort inDj9`l- <br /> r a� p4�vi . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION <br /> M <br /> ,PLU _B1N,G,�?�RMIT APPEICATION <br /> FixtureFixture 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 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 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 /> SPMN:4M t SUPPRESSION SYSTEM, Sewage Ejector or Sump Pump Other 1/000tei 4'C WeY 11(XV <br /> Water Suppression SystemNo.of Heads <br /> Chemical Suppression System I 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 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 /> PERI�T ' of <br /> Owner/Aut Ized Agent Signature ef- <br /> Date (Revised 10/10/2018) <br />