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PERMIT APCATION <br /> /10%4/—.---A BUILDING-CHANICAL I <br /> PLUMBINGPLI/SIGN _ IINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> vliiiiz y 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT;SITE INFORMATION <br /> PROJECT SITE ADDRESS: IN/7 Ru Ire,* PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision _ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A,, ,Li y'(Jt,)ccr l i� . T ANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET {q/7 gut(ef �,d I <br /> CITYerSTATE VV c ZIP 63 <br /> OWNER PHONE:Oa-5) OWNER EMAIL: /1/640/ ... //) N3 4 <br /> c, <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> ,_.... ..w � ,�. _tir ,... ,,,,. .�. . �� _. �, <br /> PRIMARYCONTRACTOR 0 OTHER(Please Speci <br /> CONTACT: OWNER 0fy) SW•ocAleAs w Ocr,f 1,i <br /> CONTACT N,yy E: CONTACT PHONE: tifz ) z -- Z <br /> O( /, ip CONTACT EMAIL: ft rd is �i/' 4 iiar .. �. • �v r,. �,C <br /> cm <br /> BUILDING INPORIVIATIOI+I <br /> Existing Use of Building ,:'Y Contract Price of Work:$_ _ _ <br /> Proposed Use of B ilding: ._S•e/Q• -Y <br /> __ _ __ -Heat Source: IRGas V lectric a Other <br /> BUILDING USE: FR ❑Townhouse 09uplex ❑ADU ❑Multi-Family-#Units: Commercial ❑ essory Structure <br /> Type of Project: ❑New Addition N4emodel ❑Repair 01-.I. ❑Sign ❑Sprinkler RIDemolif Change of Use <br /> DESCRIPTION ORK /delp_ ei IRL4220,777 <br /> , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <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 i Backflow Preventer(Inside Bldg) If Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher I Sink-Residential(kitchen,bath,bar) <br /> _ Duct System(Remodel) Refrigeration Drinking Fountain _ T 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/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression SystemNo.of Heads <br /> Chemical Suppression System I INo.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 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 /> 144/9( <br /> g '''' ' , , 1/ CI:\,i a PE ITkcii. ‘,e2 () <br /> \., <br /> Owner/Authorized Agent Signature ,' to (Revised 10/10/2018) ti <br />