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IEEE <br /> • PERMIT APPLICATIO• <br /> 11.1 <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: .' U ckS e (x l',t `Dial rj„Q Cl gal PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: i,C0co 12e_,12jn er TENANT BUSINESS NAME(Commercial): V4,\ et-: Es,12 ►awz C��XvA-tx , <br /> OWNER MAILING ADDRESS: STREET 3`'30 K.JC0.0J2-S* 0 <br /> CITY e\/l. STATE (ADA- ZIP et 3aCal <br /> OWNER PHONE: I'Av A5C5n LC) 14;6-1+ Fct OWNER EMAIL: bt ( 0 .. M zt^/3.-Ae(2 NyooeiAgnt ;1yl <br /> CONTRACTOR NAME: L✓ -i I L�OI Y/ C� . LC, <br /> CONTRACTOR ADDRESS: STREET Q . .e C� <br /> CITY \u`1 l-t STATE W._ ZIP GI 3c4 <br /> CONTRACTOR PHONE: c (p cS\'� ssct CONTRACTOR EMAIL: ;�U lid) CD Mr.��' +-ric ,CCtm 1 <br /> CONTRACTOR LICENSE#(REQUIRED):t\AcY-41.)Cifi,i2.0VJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER pt CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 3ivkt1 e_ PD\ In CONTACT PHONE: ac)� <br /> u t CONTACT EMAIL: \e\*")( , <br /> BUILDING INFORMATION <br /> Existing Use of Building: MCV 6‘,C,(k. (�;�1 Contract Price of Work: $ <br /> Proposed Use of Building: Red l & UL, Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: lArommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign 12rsprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 26oCct cxi L1 . lclni- le,x.wYq)s 1rk5 ; \uct L. <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/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> ater Suppression System {,t 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 /> PERM( #yvoo� - oas <br /> Owner/A horized Signa ure Date (Revised 10/10/2018) <br />