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MUM PERMIT APPUCATII <br /> 12 <br /> BUILDING / MECHANICAL I PLUM;ING / SIGN—) SPRINKLER I DEMOLITION <br /> EVERETTCITY 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 Black Ink Only Please) PROJECT SITE,INFORMATION <br /> PROJECT SITE ADDRESS: 2ODD /cwt/ 94r41-- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Evert 1 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET ore 7',),. • s¢' <br /> CITY E,,,evL 79- STATE {a.,' : ZIP yfj3.2 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 4n6 C.,orj j/f-/per! <br /> CONTRACTOR ADDRESS: STREET t ?V /7D''4/a2 42" <br /> CITY 6l/1j/,0‘ STATE lid ZIP fkDcyr <br /> CONTRACTOR PHONE: ),,Q/7 797 77 'f' CONTRACTOR EMAIL:ilec�4�e.sera,"0.6, ,4�, <br /> L/3 <br /> CONTRACTOR LICENSE#(REQUIRED): GGOG. g-31,4G' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): D 7/, <br /> PRIMARY CONTACT: ❑ OWNER ® CONTRACTOR ❑ OTHER(Please Specify) �/ <br /> CONTACT NAME: <br /> I _ ' CONTACT PHONE: ) 7`/7 77f7' <br /> // cc I 2.G�/.c711 CONTACT EMAIL:,A4 44i„g//.�„,,,+41/2 ll.4.4 , X 0,,0,7 <br /> BUILDING INFORMATION <br /> Existing Use of Building: SG`ide Contract Price of Work: $ 3 ,/:.‘"9,3 <br /> ` <br /> Proposed Use of Building: //// Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: pCommercial DAccessory Structure <br /> Type of Project: ❑New DAddition 0 Remodel El Repair ❑T.I. DSign ❑Sprinkler DIDemolition ❑Change of Use <br /> DESCRIPTION OF WORK:4-'04e, <br /> ®`� ivadj.,' ed.-rG/ ob CaCt.f/`�/NQ.$40).?. /friesedv/ q fis4efe, <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 Unit> 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 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.1 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 /> / r 7 - PERMIT#T \o bg O <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) 7 1^� <br /> G <br />