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PERMIT APPLICATION <br />BUILDING f MECHANICAL 1 PLUMBiOV SIGN / RINKLER 1 DEMOLITION <br />CITY OF 0ERETT PERMIT SERVICES <br />3200 CEDAR STRE " WA 982t01 <br />(£ 5-25;r-88-10 ; I FAX 42 2ti7-885.1 E) evsrett ps ev raCtuva. ov u�v�w.everettwa.gov/perMiis <br />PRnJECT.SITE INFORMATION <br />[PROJECT SITE ADDRESS: - rJ 4 y (X)1i <br />PROPERTY TAX #: <br />[LEGAL for new const; uctiM Short Piat/gubdMsion _. . , � .._ �, Lot No,__ (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: %)_ , t �� w � � f � � �� � ' TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: <br />czy$' STATE C k-� A ZIP <br />OWNER PHONE. � �n � � � � �: � <br />gWNER EMAIL: � ;�>`�� .� "� `'��� �� t"�� ' „���• ��� ,� . � ,� <br />CONTRACTOR NAME: ..=I �k ', <br />CONTRACTOR ADDRESS. STREET { <br />' CITY STATE ZIP <br />CONTRACTOR PHONE: , {��- , P y " j <br />CONTRACTOR EMAIL: L" t�}t . V � k °�� "I <br />lc t <br />CONTRACTOR LICENSE #(REQUIRED): �.�'< t <br />CITY OF EVERETf BUSINESS LICENSE #(REQUIRED): ','' i (C;� <br />PRIMARY CONTACT: ci OWNER ONTRACTOR ❑ OTHER Please Specify) <br />CONTACT NAME: ONTACT PHONE. '�' 1i •� <br />CONTACT EMAIL: <br />BUILDING INFORMATION <br />Existing Use of Building: �����• � � Y i � t _ � �� <br />Contract Price of Work: 5 11�1 --' I'� - <br />Proposed Use of Building: 2 -t"' LT 'i: t w # <br />Neat Source: ❑Gas ❑Electric E10ther <br />BUL LDING USE: 0SFR OTowoho>,se ❑Duplex ❑ADU ❑rvIulti-Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ORemodel ❑Repair EDT, . ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK Z <br />S'� !i trC.(ti <br />- 3 C_ <br />l{,.SSOCIATED BUILDING PERMiT # if applicable): <br />MECHANICAL. PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Ctrtfrsf <br />List of Fixtures <br />Ffxtun <br />Cnurrt <br />List of Fixtures <br />Fixture <br />CpUflt <br />List t5f Fixtures <br />Fixture <br />irputlt <br />List of Fixtures <br />FDIC — Air Handling Units <br />Gas Pipinq <br />Back#low Preventer (Inside Bldg) <br />� <br />Shower, Tuh, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />SinkCommercial(3-comp,prep,floor) ' <br />C:lotha� Dryer <br />Neat Pump&DJctIPss <br />Dishwasher <br />Sink -Residential (kitchen,bath,bar) <br />DvrtSystem (Remodel) <br />Refrigeration <br />Grink;rg Fountain <br />Sink-Ufllity, laundry, mop <br />Er,l,°st Fans (R: sirientW) <br />Commercial 'Ventilation <br />(Not HcatIAC system) <br />Floor Drain <br />��- .�-- <br />Toilet <br />Exhaust Huc�d (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type it) <br />Water 1-1pater <br />Interceptor -Grease <br />Waste,Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-SandlOil <br />Water Sen+ice (behind meter) <br />Forced Air Systems <br />Cithcr: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace{Insult og <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTiEM <br />; ' ge_Ejector or Sump Pump <br />Other: <br />m . ' uP,Pressivii System <br />No. of +r Ids <br />"' ' " <br />Chemical Suppression System' <br />Nr',, of Hdad:, <br />- <br />t 1ft1OWLEDGEME IQ i,o g o (lowed t <br />YYrssni'fcrfsxrAl €'fsifP AAr/. 'im.§�i�9iu4P i'AA .rrr'nn <br />ifs appim;Mion and cofrftrm the tnfrmtrrra(torr <br />Nn�rSf .l5BYmli v.nf ,,,}h.y r, <br />corltaiiied <br />.,•.,.I ...... <br />herain is trua and correct. Work done pursuant to this permit must aorrrpiy wiih <br />t. :....i ,_ <br />- viul,ill lJ iflLdt f(raI11 1-111 1 Ill WIjV"!4 Ft t t 3 <br />f3iti4ding Official before f,c tng a afhorizodunderany clrcumitance. Ian, the own or or 1 am authorized by the owner of this property to perform tre .aorh f7r Klh�ch �pptr 3.,Y rrlba�'E <br />and t comply With the Stat .antra tors Law 18,27 RCW and 296.200A WAG. <br />!! City taf EvBraft Official t i5o Only <br />PERIVI-rig <br />arlAuthcurxedAge r>#Signature <br />Date (Revised I0,1f0v2 18) <br />