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emu 'I PERMIT APPLICATION III <br /> BUILDING I 'MECHANICAL I PLUMBING /SIGN I!hkINKLER I DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> K 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> or,Black Ink Only,Please) „ PROJECT,SITE;INFORM�AAT,I,ON. „ , <br /> PROJECT SITE ADDRESS: III 9e :..tvetzEtr kJ_, WA'1 P S PERTY TAX#: • <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long le. description) <br /> CONTACT i.NFO. ATION. , . ....: <br /> OWNER NAME: ot-rriOF .g, T. 'ANT BUSINESS NAME •.mmercial): <br /> OWNER MAILING ADDRESS: STREET fil/ or <br /> CITY V.i-� • STATE imA ZIP elog...0( <br /> OWNER PHONE: 4,15 - Z�j�- X02. �- OWNER EMAIL: GI, rk eV eyef"Wa.„ <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONT- CTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED. CITY OF EVERETT BUSINES (CENSE#(REQUIRED): <br /> PRIMARY CONTACT: IJ OWNE• 0 CONTRACTOR ❑ • HER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,4„Z� <br /> c-11P4s CONTACT EMAIL: G rk. Lo(���-�'w�• oV <br /> .BUILD,ING INFORMA o N. <br /> Existing Use of Build', j) l.E .0106 . Contract - ice of Work:$ 57c2!050 mak, <br /> Proposed Use of Building: C Heat S,,urce: ❑Gas 0 Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑■ plex ❑ADU ❑Multi-Fa y-#Units: &Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition 0 emodel &Repair ❑T.I ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: V 'PMOL , �Nrc- Rep <br /> J14501-A'lc l _M ._A =a N l.. - _9 • 1= MEMBZ 4E _APEX LM ► "EL <br /> Vzvi 9a, sIVA0.4:e '1"17 <br /> ASSOCIATED BUILDING PERMI #(if applicable): <br /> MECHANICAL'P. MIT AP..PLICA1TION PLUMBI,NIG PERMIT.APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixture- Count List of'fixtures Count List of Fixtures, Count List of Fixtures <br /> NC—Air Handlin% Units Gas PP,ng Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Mange Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer, H:-t Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct Syste (Remodel) "efrigeration 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(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 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 l 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 1121 <br /> 0(.0- 0111 <br /> Owner/Autho zed Agent Signature Date I (Revised 4/15/2019) <br />