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Mfgo PERRIH1 APPUCATRO <br /> ?. ZULDINOMECHAMCAL. I PLUMB G I S G W PR NKLE / DEMOUTRON <br /> V CITY OF EVERETT PERMIT SERVICES <br /> Ir d i� IT If CITY <br /> 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 RNFORMATU'11 II <br /> PROJECT SITE ADDRESS: 92/o EV.f rl),eerir km,/ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _ ___ , - <br /> _ CONTACT INFORMATION _ <br /> OWNER NAME:/-"&% ,'c 1/1 TENANT BUSINESS NAME(Commercial): l l T76l,� — <br /> OWNER MAILING ADDRESS: STREET hy l/ff /-2/ ,fGJ i <br /> CITY C:V?Ye..----(.'44 STATE 1/t//r ZIP f XZG4 <br /> WNER PHONE: 7Z3I OWNER EMAIL: ' /-fvan> lfa7q-r��fi ot(/, cOri <br /> S 1 3SU - <br /> CONTRACTOR NAME / /, <br /> CONTRACTOR ADDRESS: STREET '4() 3 )/ 70(2_ ,,/ (� <br /> CITY fB �e U/� STATE •�/V, ZIP 9/�DO jj <br /> CONTRACTOR PHONE:025) 33S I -.34,9U CONTRACTOR EMAIL:lickma5orgryietseviio-/.-erli rs .oil <br /> CONTRACTOR LICENSE#(REQUIRED)1 A,:. fL'^,l j;7,i,\: CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S(,- j 7(,.' <br /> PRIMARY CONTACT: ❑ OWNER O CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (125) 3 S I - 3(, go <br /> i , V CONTACT EMAIL: �7/6/6,4ri svn (0 444 SU✓ll n.-f-G✓r r:; r. <br /> BUILDING INFORMATION <br /> Existing Use of Building: rfGt/ e - -7 c. I-1/C Contract Price of Work: $ ,! C' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � n <br /> &eA14- fair\ c h1 c L <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Count Count Count Count <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 /> 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 La 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> M# r <br /> s 6-(__. a ---- ', . '-'i',, ,' .9 — 0 2:-2 <br /> Owner/r uthorized Agent Signature Date (Revised 4/15/2019) <br />