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SP PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> ,01W-.71-1� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps(geverettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESSL7y�V dt1Pi9 'jay �']f&N ire 1,OP #.2 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision "� J Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:lift 1)�`U?L pc Pki 1 Lai TENANT BUSINESS NAME(Commercial): i iii �jC piPty s <br /> OWNER MAILING ADDRESS: STREET (1,183 tl f j1j ‘,/22/./e t <br /> cn-r 1 l.oq?lm STATE (A ZIP(9t - - - <br /> OWNER PHONE: 6;/2-&-2,,/- ( /,1. OWNER EMAIL: <br /> CONTRACTOR NAME: , ' 5/11/60►'ales <br /> CONTRACTOR ADDRESS: STREET ' W/(GYJIrfj 96Yy Wile fr. 51e,`/`v <br /> / CrrY ?/� . STATE i /�/ ZIP 05e)05 <br /> CONTRACTOR PHONE: 67 1j5-3 zoo CONTRACTOR EMAIL: &eV/01K mL'(?Q e,C12)-y) <br /> CONTRACTOR LICENSE#(REQUIRED):14( 7f / 1001 Cu CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ,f <br /> PRIMARY CONTACT: 0 OWNER $CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: k)(,,'' ' .,c1)-Si-(-b Z 33 CONTACT PHONE: <br /> X43-531 - b2,33 <br /> CONTACT EMAIL: d pi y^ J ryl,4ie,,ec„nlbfaAAle lt-ILole,CQrvi + <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$4k J 2 OOU,-- <br /> Proposed Use of Building: Heat Source: OGas DElectric ❑Other <br /> BUILDING USE: ❑SFR DTownhouse ['Duplex DADU ❑Multi-Family-#Units: 1g€ommercial ['Accessory Structure <br /> Type of Project: ®New DAddition ❑Remodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> !ariv)1,X+J utt (,� Gv , t l>rP l &PO &YMI6L Sale, t. ),-)er 8 L <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ?)/2:05 "£Y4 <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 /> NC-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 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 /> • <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.!am the owner,or!am authorized by the owner of this properly to perform the work for which application is made, <br /> and I comoly with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> l? <br /> City of Everett Official Use Only <br /> Z� �. PER \ct % C)S� <br /> Owner/ th ed Agent Signature !� ate <br /> (Revised 10/10/2018) (:-D <br />