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SIM <br /> lial PERMIT APPLICATIOIL <br /> BUILDIiMECHANICAL I PLUMBING/SIGNOR.PRINKLER 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 J(E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> BIB*or <br /> Bleck iek Only P1j; . PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �� 4 IMrt!) � 'c. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: UD PN ivice• TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 17 9 5 5 lie, c.e.,,i`re,,/' Q r <br /> qy �j --c S `-%� STATE d A ZIP go z <br /> OWNER PHONE: /,20)42,CJ 3 I�0 OWNER EMAIL: I f ec,,� ti STpz Q V I)P---. , 6.0.41 <br /> CONTRACTOR NAME: <br /> AA kJ) PI <br /> CONTRACTOR ADDRESS: STREET )f3Y )0.5 _AU."ds <br /> cr- <br /> aw 6;1 /''cr. STATE J4? ZIP 85.�CSS <br /> �y t� G. <br /> CONTRACTOR PHONE:(56,6)-2C92_— )p l CONTRACTOR EMAIL: �e��1,�e/ _ /4444/4-�P.�Jt.iby 9 ( 44 <br /> 7 <br /> CONTRACTOR LICENSE#(REQUIRED):GO 4- 9 7G—1 Lt Li CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �J <br /> PRIMARY CONTACT: ❑OWNER cliCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Cit )S 13 _ 7,3b5 <br /> M 11fi� \ Fe_5 A... CONTACT EMAIL: 1 ke 0 !"�.. ll,Ipl , 7.'w> <br /> BUILDING INFORMATION Tis <br /> Existing Use of Building: Contract Price of Work:$ 9d jam <br /> Proposed Use of Building: Heat Source: OGas DElectric DOther <br /> BUILDING USE: OSFR OTownhouse ODuplex DADU Multi-Family-#Units: [Commercial OAccessory Structure <br /> Type of Project ❑New OAddition DRemodel ORepai OT.I. OSign OSprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> Rep -cse.. cy vc... w '' P,P'e .,.,jilt, iPex PiPe-) ( Ike- i I fie_ <br /> ASSOCIATED BUILDING PERMIT#Sif applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fbaure 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) ,3W Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless t4 Dishwasher .,„r" ink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 3_.3 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 Fatures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER 1 SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System fNo.of Heads <br /> Chemical Suppression System No.of Heads _ <br /> ACKNOWLEDGEMENT.:!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 be g authorized under any circumstance.lam the owner,or l am authorized by the owner of this property to perforin the work for which application is made, <br /> and I comply with the .'te • tractors Law 18.27 RCW and 296.200A WAC. <br /> ,./ City of Everett Official Use Only <br /> PERMIT# <br /> ip loi ) ...----' <br /> Owner/Authorized •a ent Signature Date (Revised 10/10/2018) <br />