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II PERMIT APPLICATI I I <br /> nig <br /> BUILDINLMECHANICAL I PLUMBING/SIG IYPRINKLER/ DEMOLITION <br /> EVERETTCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or',Blatck Ink QnirPleasef ',..... , PR. 3JECT Siltit O M TIO0., . ., „ > .,... t .,R,i <br /> s 4 <br /> PROJECT SITE ADDRESS:GKo -.pyf i4ug /PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot Nobtal ttach copy of long legal description) <br /> . .. . ..... .. .. . ,'CONTACT 1 M R�IRIVII�,TM(�I`� . <br /> OWNER NAME: rk'io-k--- D-o1 N,(,�j t/t,O'oev1 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS:::: STREET/.`01,0 •Qoy4- PU: <br /> CITY aQ STATE W 0- ZIP C(2- .0 , <br /> OWNER PHONE: . "Z��6 8 OWNER EMAIL: f c�, K�' 1 Co-w-x. <br /> IRS <br /> CONTRACTOR NAME: OWylec, <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: Ei'OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (4Z5;):7_13.-.6xi`t$ <br /> il1494 7aUtt.c--)/4o4 c.k' CONTACT EMAIL: al;-4-J,l �cJ J5y,„,„1•coN'v_ <br /> :,.. . .. . G INP .J <br /> ;BtIILDINh RiN1AT10N ,-...._. <br /> Existing Use of Building: ( •jta2V\M1 \ Contract Price ofWork:$ 1 -'),C/C) <br /> Proposed Use of Byilding:(110,6 A Q)e5\Atvlc-( - Heat Source: 12//Gas DElectric ❑Other <br /> BUILDING USE: LISFR ❑Townhouse 0 Duplex DADU OMulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition 0 Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler CI Demolition 9Change of Use <br /> DESCRIPTION OF WORK: <br /> ( 4v cJ CAtr}Mt5lt7)14e(A) S0,141Q Quw1? t <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 'MECHANICALSPERMIT APPLICATION . ,. PLtJMSINS 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 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/Insert/Log Roof Drains Water Heater <br /> „SPRINKLER 1 SUPPRESSION SYSTEM, Sewage Ejector or Sump Pump Othe6Asmo casMc -,)(-- <br /> Water <br /> ,)rWater Suppression System No.of Heads I UdISYlery(' <br /> Chemical Suppression System No.of Heads. <br /> ACKNOWLEDGEMENT.1 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 /> PLR I it <br /> 1Swner/Authorized Agen ignaZ Date (Revised 4/15/2019) <br />