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PERMIT APPLICATION <br /> BUILDINCIIPECHANICAL / 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: [ 7(.7 c( G V G/'wZ-7v L.Jy PROPERTY TAX#: .28OS-t);7c 0 66c90 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ✓L � /��;,,� L( C TENANT BUSINESS NAME(Commercial): " 1 12Z4 <br /> OWNER MAILING ADDRESS: STREET 6 f;� (41,> I6 N> Si- Cry -7 <br /> CITY -S f-(v�L�CI„-SC- STATE ZIP r0 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: MI L S/(-y) Ce , I NC <br /> CONTRACTOR ADDRESS: STREET no'Z6O - �j� 7 .S� ,�J <br /> CITY Mot-WI— VL='V,� \ STATE 1,-14 ZIP 7-2 <br /> CONTRACTOR PHONE: S�60. `f �(. /3 CONTRACTOR EMAIL: 1-c 1 ir-S Pi 60: C � <br /> CONTRACTOR LICENSE#(REQUIRED): �C—YC./E_ C �'i,J38 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ECCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: j G0 <br /> C2 L CONTACT EMAIL: ,o ,,ram Mc y��2S'/67L:. <br /> BUILDING INFORMATION <br /> Existing Use of Building: /e u,E',gyFt Contract Price of Work: $ f`(1 OCO <br /> Proposed Use of Building: i s'r th,q,,Y' Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse Duplex ❑ADU ❑Multi-Family-#Units: Ofommercial Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. sign Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1 <br /> :1—r�SrArc a t—4cc SiG-, & AI&t- CA:1'w�>y �u Cx�sTr>JC kw �I€* , (L() ��tpcpCJ.t,�a�s, <br /> r i e <br /> 4,4y c,6e41-lxrPds C � ' rave � ���"'� /�,�u ( P4, '1 czvli <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1610 -O`Z- <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 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 /> PERMIT# <br /> _ Cr6 � t • <br /> Owner/Authorized Agent S' ature Date (Revised 10/10/2018) <br /> I12- <br />