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1z PERMIT APPLICATION <br /> BUILDING-CHANICAL/PLUMBING/SIGN RINKLER I DEMOLITION <br /> EVERETTCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 ( FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Bl o or Block Ink.Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ROI ivves,1) Cie Jj Z Q„rT* A PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: U D P i Wie-s. TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET )7 9 5 5 l .1-re,- I)r <br /> CIN 6u'tQf C 4.-.1 STATE ili ZIP go 2. <br /> OWNER PHONE: 720)07„ )3 . 1,20 OWNER EMAIL: H-eat...Piti 5Tp r e, Q 0 b R.,, CO(41 <br /> CONTRACTOR NAME: AnA lei's P . <br /> CONTRACTOR ADDRESS: STREET 3 % I ) ,5 +^t e9 >$ r <br /> cm' / .P V STATE A z ZIP gs iZ 9S <br /> CONTRACTOR PHONE:(13&0-2C72_,-- )€15 CONTRACTOR EMAIL: Rc213ei-r ,A41A-lei 1P/ , Ce944,1 <br /> CONTRACTOR LICENSE#(REQUIRED):6304-s 9 7th) }_I y CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): iCetii, i <br /> lg.' " <br /> PRIMARY CONTACT: O OWNER CONTRACTOR CIOTHER(Please Specify)r q All IA <br /> CONTACT NAME: CONTACT PHONE: ( o)553 _ 773 / <br /> m iC,1 %A.A.\ Fes-T-2 CONTACT EMAIL: v11 i 0 AiitA 44,4)1 vl, Gt7f� <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 70 1000 <br /> Proposed Use of Building: Heat Source: OGas ❑Electric OOther <br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADUMulti-Family-#Units: OCommercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repai ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> IZeplA- c-Pv6._ w Pik 14.1` i�e �Pt�De 11 Y-e. �" 11 '� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION, <br /> FbaureList of Fixtures FixtureFixture Fixture <br /> Count coupe List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units _Gas Piping Backflow Preventer(Inside Bldg) ,. 31-1 Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless ,,„2J4 Dishwasher 7S AR Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 3N 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 It Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I No.of Heads ' <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the infonnation 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!comply with the tate Contractors Law 18.27 RCW and 296.200A WAC. <br /> iA/ City of Everett Official Use Only <br /> PER <br /> I Ya�� I. ")rot[ J 0-?_ <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />