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® PERMIT APPLICATION* <br /> IMI <br /> BUILDINe'�. MECHANICAL I PLUMBING I SIGPRINKLER 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: -7 1 0 O (/vVV e t<_,D c PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision--- Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 4Y2gt,rb01,ra._, l Gt/Y\10beII TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET J.-71 a( ©1_9'et t rOI 7 <br /> CITY {,C.(—C� J STATE Alit ZIP 93=3 <br /> OWNER PHONE: 01.)(5..O(D g'qd` OWNER EMAIL: Saq,r'�1GS5 5 I @ 9 ► al I <br /> CONTRACTOR NAME: TREE oki1I/Z� <br /> CONTRACTOR ADDRESS: ST <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: M OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: r►xc cpx caAry I7e-1/ CONTACT PHONE: V.416 61 VA,I, <br /> CONTACT EMAIL: �Qctril e$s @ perk,1 I. C.B/Y( <br /> BUILDING INFORMATION 4/ <br /> Existing Use of Building: S F (`� Contract Price of Work: (QC�, <br /> Proposed Use of Building: S F- 0 \ Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: Ga'gFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 4ze,b4 <br /> m now I^ d qn t,�,h�i e7 /5hec( b as .nen,'fr <br /> L'ae o tt)0.`�"eT— o siv�<'AnF`� �1 F�1SE'c91�!/�1' <br /> Cabo d LJoO t ,t— l - .0'4.k. eha-n n <br /> `cC,wtovc �rJ''ua 14 �'b fe✓Ca, ,,ttnrtA, <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/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 jr 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 /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) <br />