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MN PERMIT APPLICATIO <br /> BUILDINOIIECHANICAL / PLUMBING /SIGN RINKLER/ 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: 2 003 CALesS'* CO �t7 ��I IVC{ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision 4O'.5 0 Lot No. (attach copy of long legal description) <br /> _ <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET ijtS LL) 3 ( kc o Ja‘7( <br /> CITY " STATE L,J <br /> , ' -� `PS ZIP lac & <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 12,1(\n,1-.uaSCN\ CCNYI pli-1� <br /> CONTRACTOR ADDRESS: STREET 122 ` ?v d Pcue IU <br /> CITY ....'CAr b"c STATE LA\f ZIP CVOS 2 <br /> CONTRACTOR PHONE:Z'% --65d- 7(( -7 CONTRACTOR EMAIL:`_ j(trvi,, J \S(j <br /> C Son0,“ova' 1r '. (cV), <br /> I �CONTRACTOR LICENSE#(REQUIRED): 1(YYl(A c (X);S,(R \ CITY OF EVERETT #(BUSINESS LICENSE REQUIRE <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 761 -3 sq-'1/(-Q) <br /> evu, 0,1 CONTACT EMAIL:J�;IJ j I Q • K)63-0+'1 YiV rnU✓i ,_ C O h <br /> BUILDING INFORMATION <br /> Existing Use of Building: l \Ol-{V--G -1\.)\1,ry Contract Price of Work:$ Y(-! r 000 <br /> Proposed Use of Building: v-In ,n�) Heat Source: ❑Gas INlectric DOther <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex D DU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel pair ❑T.I. ❑Sign OSprinkler ❑\Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> c2e(;) t,e., 1 (e ke G-v -Q C (AA Q v <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 /> NC—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/AD 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 2. Other:e.QYIt ✓taJ- 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 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 /> 1O\ \el PER` ` \ r; 0 _W\ <br /> Owner/ thorized Agent Signature bate (Revised 4/15/2019) / <br /> I. v <br />