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PERMIT APPLICATIAll <br /> BUILDIII/MECHANICAL/PLUMBING /SIG1r SPRINKLER/ DEMOLITION <br /> ellirW/CA- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (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: 321 y &MAL.,(P y PROPERTY TAX#Z 0ititiD7oo <br /> ao/ tiwooc)frevi <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:atmAIa/it) AAAtinfivi5 e.3z,9U/ZIENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: smEET(UO _/(cam- ANc dj s V A �i�, <br /> CCM' ROi , C Vee,p STATE /� ZIP 7{{6,'4 <br /> OWNER PHONE:2 4 zgr 7fl0 OWNER EMAIL: , Aeli/E1�le(7,CQ r7 <br /> CONTRACTOR NAME: e c t ...e(c Cficid k, L t 4,,Q <br /> CONTRACTOR ADDRESS: STREET "' LS <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):Anig.018077KF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)::Cg$.3`. <br /> PRIMARY CONTACT: WOWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME:64.1/C ,$-N CONTACT PHONE: 2j 42 Cr 7S'id <br /> CONTACT EMAIL: 4]c„;1-e✓jt/n 4eeJ7, coin <br /> BUILDING INFORMATION <br /> 1 <br /> Existing Use of Building: Contract Price Work:; I i&� ode <br /> J <br /> Proposed Use of Building: Heat Source: IGasElectric ❑Other _ <br /> BUILDING USE: Os�.�( R ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> 16I Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: MS /WO L4/0 T ,41 t 7C.v7 Com�1�C <br /> ASSOCIATED BUILDING PERMIT#(if applicable): R I',/(�-051/' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fbture Fixture Fixture <br /> Count List of Fixtures come 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 /> /yQ Clothes Dryer C 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 Ventilator Floor Drain Toilet <br /> fie Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease WasteM/ater Piping Repair <br /> `y/ Exhaust Hood(Residential) Wood Stove _ InterceptorSand/Oil Water Service(behind meter) <br /> Forced Air Systems <br /> Gas Fireplace/Insert/Log Other. Medical Gas <br /> Roof Drains Water Valves or Fixtures <br /> Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System t No.of Heads <br /> Chemical Suppression System 1 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / /�l}j\ City of EverettC Official Use Only <br /> r eill /' i6114.4el 1l,7y PERM 7 1# \04 'O ��Owner/Authorized Agentnature Date (Revised 10/10/2018) <br />