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® PERMIT APPLICATIO, ' <br /> ILO <br /> BUILDINIOMECHANICAL / PLUMBING / SIGNWPRINKLER/ 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: 'Z/O eve y y-e-Q j11 U(/Gc,./S-TE PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: LC'C) j a (-I-j,- n TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET f O t( %/ CI- ? zt( St <br /> CITY ,(,, i,,6./`- STATE L-,Y t i ZIP C/ 0 �4 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 0/Lim /1/1 i4Q <br /> CONTRACTOR ADDRESS: I STREET ' t'd i'/ 0x -7(; z v l.)(7 C� <br /> CITY F,eI�E'.J ,E. STATE Cfr'' ZIP /D('0(..)/ <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED (VIIISUr1iN,\t`S 5LC- _ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ,S 67 8-70 <br /> PRIMARY CONTACT: ❑ OWNER 9 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:( c2 c) 3 5 ( - 36 90 <br /> l.> (( IC CONTACT EMAIL: C�/C7/Y/C j0)---/ sz fi1Gl SO4 in-ftv"i6YS . <`✓9 <br /> BUILDING INFORMATION <br /> Existing Use of Building: (eht/ ,,,,,-f r, o{(, - a Contract Price of Work:$ (G'U(9 ''' <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> AiiiIi l',, •ftre '} io Sirid'S <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 2— 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 Offi 'al 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 comp) with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> e 0 Z .I1gI .2r <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) <br />