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IN PERMIT APPLICATION <br /> BUILDIN®ECHANICAL/ PLUMBING /SIGN 1 mRINKLER/ 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_orjB(ank Ink Only Please) PROJECTs;SITE NFORMATION, . , _: .., . ,,.. .' <br /> PROJECT SITE ADDRESS: Z7®ZOq0... Luh PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMAIION;t <br /> OWNER NAME: p� TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET Ti-702 5G`r0.�G q, t.a.r. <br /> CITY 4,V im( J STATE W ZIP cis?D3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: `7 4V(I c p 1u40;A cD 6f- Doob(� 1C P([ew 1 in.? <br /> CONTRACTOR ADDRESS: STREET 1 0(") 13p\1 /If 7C J <br /> CITY , 1y.4 11Gj�DJ STATE LJ.) ZIP 9,sriffZ <br /> CONTRACTOR PHONE: 4 Z r 5'.70 -7443 CONTRACTOR EMAIL: 0 4t`" g 7 a z 7 i/s,/0mi 4, .Caryl <br /> CONTRACTOR LICENSE#(REQUIRED): iitik— CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: C� CONTACT PHONE: Li 2S— 5 (, 7L14 3 <br /> `v) CONTACT EMAIL: <br /> EI04G4 n �k, <br /> ' i;, <br /> { <br /> Existing Use of Building: ,{.S t '-14.k Contract Price of Work:$ 06.D/ <br /> Proposed Use of Building: a v-v 3c ( Heat Source: ❑Gas Il1dE ectric ❑Other <br /> p g �S L <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ‘4,, k" � ,L.4 A..� _ G1/4.5 L« /' Ay_ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ,.,MECH 1;NICAL PERMIT+APPLICATION„ R Phu BI <br /> r <br /> �. . IVI NC'r ItEem[T`APPLICATION ' , . °.. <br /> Fixture Facture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC–Air Handling Units t 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 t 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/InserULog 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.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 /> 0/0,./(3 .------__ z S` � PERMIT# l I/X\/ ,lal DOH <br /> � <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) <br />