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vs PERMIT APPLICATIOMI <br /> BUILDIi` MECHANICAL I PLUMBING i SIGPRINKLER/DEMOLITION <br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASH!NGTO N (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps€everettwa.gov l www.everettwa.govipermits <br /> Splueor Black Ink Only Pte) PROJECT SITE INFORMATION " <br /> PROJECT SITEADDRESS: ` 9 <br /> ���1 M �1�) � .44 <br /> t ;QTpi 71PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: UI R. 1hC-6- TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTREEr)79 5 5 tier,„ 6.0,11-6,--- Ar <br /> CITY hyo'ial C STATE 41) ZIP g O /,- <br /> OWNER PHONE: 7z6?0 5; - - 1,2,0 OWNER EMAIL: WeaAti STC0't e,. Qi U b P., r C.Oo`iel <br /> CONTRACTOR NAME: /61A keit t P f • <br /> CONTRACTOR ADDRESS: STREEr e % )QS Alit dS <br /> R STATE A zIP g..5.Z C5 <br /> � <br /> CnY �� ,P� <br /> CONTRACTOR PHONE:( 4 &2. el 5 CONTRACTOR EMAIL: ReZe'-T ( / 41,4 44/pi ry . Ce9Ali <br /> CONTRACTOR LICENSE#(REQUIRED): O l""9 k7G-I 11 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 'J <br /> PRIMARY CONTACT: D OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: *� CONTACT PHONE: ( o).513 — 7j,3 5 <br /> I' t)GVI&A.A F�.5� t/ <br /> CONTACT EMAIL: 'f f. f ,4 4e4A if))tiet. ce,„'w'\ <br /> BUiLDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ ,0 Ve9O <br /> Proposed Use of Building: Heat Source: DGas DElectric DOther <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex DADU Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project ONew DAddition ❑Remodel ❑Repai ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ReplA c.Pvc. w '' Pipe u1; � DIM. I I ke. � I I <br /> ASSOCIATED BUILDING PERMIT#Sif applicable): <br /> MECHANICAL PERMIT APPLICATION '` PLUMBING PERMIT APPLICATION <br /> FUrtunaL1st of Fixtures r>Mnre Fixture 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) 39 Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless 2%4 Dishwasher 75- Sink-Residential <br /> (Idtchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 39 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 l 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 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.lam the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with t.. Contractors Law 18.27 RCW and 296.200A WAC. <br /> ,4/' City of Everett Official Use Only <br /> PERMIT 10 1 <br /> ire// , CJ <br /> Owner/Authoriz-•Agent Signature Date (Revised 10/10/2018) I <br />