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= 0 PERMIT APPLICATIO. <br /> ic <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 �K'Please) <br /> PROJECT SITE INFORMATION <br /> �PROJECT SITE ADDRESS: , C ik \AD A MC-E J ' 9 -°_ PROPERTY TAX#: 0051),5 7 O 00074 0 O <br /> LEGAL for new construction: Short Plat/subdivision — Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: PeININ IS $ J ILL-- f 'A f TENANT BUSINESS NAME(Commercial): — <br /> OWNER MAILING ADDRESS: STREET t 4C7 MAID 12-0^'!1\ A <br /> CITY E\ e9.- STATE W1' ` ZIP 36D`03 <br /> ��j - ?4 OWNER PHONE: - t G O G OWNER EMAIL: (AJ ;' t C. `Y/ 0--CD 'Aki C, CO Fl, <br /> CONTRACTOR NAME: a` <br /> CONTRACTOR ADDRESS: STREET .4 `'oZ S Y C All 0 <br /> 4•Z'''""lit .' <br /> CITY STATE 9 -A ZIP 313203 <br /> �'CONTRACTOR PHONE: ‘ 0l f f j C,_> CONTRACTOR EMAIL: 3JFfCDC 06E (L-vL lv E. et <br /> CONTRACTOR LICENSE#(REQUIRED): V p CITY OF EVERETT BUSINESS LICENSE#(REQUI ): <br /> PRIMARY CONTACT: 1$OWNER 0 CONTRACTOR ❑OTHER(Please Specify)*(0),4 2 55 Lill vU <br /> CONTACT NAME: (CONTACT PHONE: 4 5- 54-3 - 6 0 6 <br /> CONTACT EMAIL: v <br /> BUILDING INFORMATION + <br /> Existing Use of Building: G F G Ott( Contract Price of Work:$ ?At 5 \ - \CO <br /> Proposed Use of Building: 6 ilk&� 1e DT-.i — ❑Heat Source: Gas DElec lc DOther N/'Pc <br /> BUILDING USE: filSFR ❑Townhouse ODuplex DADU DMulti-Family-#Units: CI Commercial DAccessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel gRepair ❑T.I. ❑Sign DSprinkler DDemolition OChange of Use <br /> DESCRIPTION OF WORK: R'� LAcc— (2_00F Sv. 1.;,-1 t Tl-} PVC. k-}-P �.O opt 1�6 - VS:PLAC <br /> (-PkiLif G5 v,) i1 cc(:A Mov,Nr 3Gi' NIGH 5iNG(..-lam TOf i� O i_LT <br /> sys , <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 Ventilation 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 I 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 w 'h application is made, <br /> and I comply with the State Contractors . 7 RCW and 296.200A WAC. <br /> Ci r ergtf (i [ —, <br /> 'S 9719 PEA \ 1 oc, —0—(3 <br /> Owner/Auth rized Age ignature Date (Revi`seeed)4/15/2019) <br /> 9 9 <br />