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min PERMIT APPLICATIOM <br /> Uri <br /> BUILDING I MECHANICAL I PLUMBING / SIGN 181iRINKLER I DEMOLITION <br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: JO CO Oh S.1/Z U) t vele t I.d.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: -V.,1t .- Ame-+r`v CA TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1115 S�hc-4 QUG S�,le Id 3 <br /> CITY GC(t}`J''C STATE t/"A, ZIP ✓Y/ Cit 1 <br /> OWNER PHONE:26*—L-14(7-no3 OWNER EMAIL: Sema/Ae12 INCA )e. -ca. - Coma <br /> CONTRACTOR NAME: k l ,U Coy Y-i (, > <br /> A / <br /> A_ It. ,A el (t n <br /> CONTRACTOR ADDRESS: STREET 'PJ 6 6 12( �'� G i(1,CI.a fix' C J A <br /> n CITY 6 V�a�7 V�✓t1 STATE (J 6 ZIP <br /> CONTRACTOR PHONE: 20C Sy(1 — CONTRA£TQR EMAIL: • e s�?r�vc kt� W/r) <br /> CONTRACTOR LICENSE#(REQU ): V 1 4' *__ ITY OF EVERETT BUSINESS LICENSE#(REQUI D): �1j <br /> L. <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �b " J, 9669 <br /> recL �bk2,1 CONTACT EMAIL: .�co6). 0 �r,1,(,Y/.�Q,.,[�rx---1 <br /> BUILDING INFORMATION <br /> Existing Use of Building: ;tco,S,A5 g, e.4. 'Contract Price of Work: $ - <br /> Proposed Use of Building: 1 2�)J5,n(S Difl c& Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU EgMulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ORemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1=- <br /> r n 1 <br /> Ic z ,lot Ci.1Q ,e h i.(4,/ S bt v1C� 0.4 0,S atr✓11�C�r�LQ DU✓/4 W 0 <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) d Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher 5 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration ( Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 4 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/InserULog 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 /> City of Everett Official Use Only <br /> 1 �-7-1 T <br /> Owner/A thorized Agent Signature Date (Revised 4/15/2019) <br />