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4E7r PERMIT APPLICATION <br /> BUILDINd 1 I`JIECHANICAL/ PLUMBING /SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Ct'2); ikc)c Y•JQ_l PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision t Vo) p\C of$(Vs,2glQLo No/C14(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,)l.Lv1/�P, tf.lJ6UGA3 5:; TENANT BUSINESS NAME(Commercial): --- <br /> OWNER <br /> OWNER MAILING ADDRESS: STREET 1a f-0,(_ -- (46't?-, Dr S <br /> CITY /`{k'CI STATE �qJ ZIP <br /> OWNER PHONE: \k9,:. ��- ��Cj l5 OWNER EMAIL: 'S is r-SP) Gtr u a s P <br /> CONTRACTOR NAME: ((J$ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ut OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> r. <br /> Arf� <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building: S"1 �2 ,,� (,0 Ze> 'tapnc Q. Contract Price of Work:$ •0 <br /> Proposed Use of Building: SGlvv�� Heat Source: ❑Gas Electric ❑Other <br /> BUILDING USE: gISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: mercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler CeDemolition ❑Change of Use <br /> DESCRIPTION OF K: (� <br /> 3R.-PiO 1,;1-51* oS c K <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 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/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 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 /> nt Si <br /> - n 11 '�CCity of Everett <br /> Official Use Only C <br /> ice v7. U P Wt v� S <br /> Owner/Authoriz geture Date (Revised 10/10/2018) <br /> Wk°l OZ - 00 <br />