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410 <br /> PERMIT APPLICATIO. <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> EVERETT CITY 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:II(.4 Ly ri rL...,,n5 t-r im uUC ((7 PROPERTY TAX#: 7 s r, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) 7" <br /> CONTACT INFORMATION <br /> OWNER NAME �(1(61 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: GAS <br /> �5 L ri, i l <br /> cm'~ /� STATE � ZIP / / / /7 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 12_, S 1 r Pc'- i I�� <br /> CONTRACTOR ADDRESS: STREET ZQI <br /> CITY-2,e_t,,(` irLe f STATE LO ZIP 9i9c9--10.' <br /> CONTRACTOR PHONE:3 (7/- /= CONTRACTOR EMAIL: Leirre(P -S f,,yy/ ` . ,00J <br /> CONTRACTOR LICENSE#(REQUIRED):5��'KW 14-© j m/e/j CITY OF EVERETT BUSINESS LICENSE#((R,E'Q'UIIRED):051Z 67/ <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: - !_7/ - <br /> Lr - - 1� CONTACT EMAIL: C>r�P �!/ _S rreMs /- 4J1'?n/�1 <br /> BUILDING INFORMATION <br /> Existing Use of Building:re-46AAri Contract Price of Work:$ /5 Z <br /> Proposed Use of Building: _SIN MC-- Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: LaCommercial ❑Accessory Structure <br /> Type of Project: New ❑Addition Remodel Repair ❑T.I. Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:r Sa�S`.k„r5 uyezi6 v5 f)3 ( 1 <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) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer _ 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 Ventilatior (Floor Drain 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/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEMENT:1 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 /> nd I comply with t -State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ) 9( PERMITS ( O 0O2,, <br /> n uthon d Agent Signature Date (Revised 10/10/2018 <br /> 9 9 ) <br />