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' , IINB PERMIT APPLICATION <br /> BUILDING MECHANICAL I PLUMBING i SIGN 1 PRINKLER 1 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 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE.INFORMATION <br /> PROJECT SITE ADDRESS: Ci.00') -� / �� . 2 U PROPERTY TAX# y D j 1(60 0 )0t "?0 CD <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: .S4q,§`ro-tAc thfirapj PM k tiA LPTENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET IS i;;,i!0 7f FTf, 4V r y 0 <br /> CITY Se T 1. STATE 'ti$JL� ZIP y (}y <br /> OWNER PHONE: a = S — OWNER EMAIL: <br /> CONTRACTOR NAME: 33t p��/ !' - pg�} c ' <br /> CONTRACTOR ADDRESS: STREET /Z 0 �,/ tlll/f jO t /-y_O �"r`E Fj <br /> CITY ArnEA/ t'l""t,/ STATE /7) ZIP ? 7;r C/ <br /> CONTRACTOR PHONE: Zo7c. —01 5 CONTRACTOR EMAIL: FF/Ca ;�,:� g .d;: xy� <br /> CONTRACTOR LICENSE#(REQUIRED): )(i=`I! o 'A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ^r fi 9 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: zob —c6 00, <br /> r t°) CONTACT EMAIL a'1 ,Q l" A L <br /> BUILDING INFORMATION <br /> Existing Use of Building: /4 L:r' ;-?/;1 Contract Price of Work:$ /6 'd <br /> Proposed Use of Building: U T/ - ( t t yf Heat Source: ❑Gas ❑'Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Culti-Family-#Units:3 'A i ❑Commercial ❑Accessory Structure <br /> Type of Project: New ❑Addition B'emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �v][ ,�gy�) t=A jai #I a t ) , 0 1 , 1 \ ,{c a , <br /> f f�!.?' @,y �"' /may% �'' ,pp e;�i <br /> y?be.A $: J'�-P.Inc tax <br /> ASSOCIATED BUILDING PERMIT#(if applicable): P) IA <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> List of Fixtures List of Fixtures Fixture <br /> Fixture FixtureFixture <br /> Count Count 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 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 Surnp 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 I_ �2 <br /> Owner/Authorizeki1 ignature /71w <br /> ate fl evised4lf l2 ffl <br /> l/z <br />