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PERMIT APPLICATIO <br /> ni <br /> BUILDING ECHANICAL/ PLUMBING / SIGN PIPRiNKLER/ 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: 100 - ItJ : A L L I, Z. .g.076 6 .PRoPERTY TAx#: t, o 5 \<6O 0 1 O 1 "7 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: M\ —44c War t ribrad 11A k .tjAl. LPTENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET J('r) ?i r r P. 4V r TT°F $Oi R,f'3 <br /> CITY ®t'" t. STATE A I"� 2iP €-' )\Q l <br /> w - <br /> OWNER PHONE: 0 ' )'6 ( —5 a y ! OWNER EMAIL: <br /> CONTRACTOR NAME: uU „70 t 6, t < 'g (NI, <br /> CONTRACTOR ADDRESS: STREET 4,r 90 / /) 6/.//�0EA] ,$/. V.0 �"t-E �, <br /> CITY ,;ay ''u y f"rJ ‘fi" `t-!A STATE /r a ziP 2-57i t{ <br /> -'oc <br /> CONTRACTOR PHONE: s �, ,'- -01 5` : CONTRACTOR EMAiL: ;� ,=';t (2? .. / _t'.o/ r <br /> CONTRACTOR LICENSE#(REQUIRED)7,;; , ..1 161`"rim ' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 2: p 9 <br /> PRIMARY CONTACT: ❑OWNER Q ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2 O 6 _cz,5'7—0 <br /> ?tkIt.k.l? tc3q D CONTACT EMAIL r. T)tc L' tV , t <br /> BUILDING INFORMATION . <br /> Existing Use of Building: fe'ttal..T';4 v- 1=.`'t l t;',,/ Contract Price of Work:$ /Z'-/3Z <br /> Proposed Use of Building: Alt.1/ t - - `yt/ ,V Heat Source: ❑Gas Cailectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU 02 ulti-Family-#Units:5= ‘ ❑Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition Remodel 0 Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use ' <br /> DESCRIPTION OF WORK: ist..,.alt t.1cjoi.g AtjeJ L- v. . n . , 15 , i 0,1 It t \L\ ('a, , ;'° j <br /> AAi 4) P t> fit 5 la a S <br /> f, A:: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): N f A. <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 Sink-Residential(kltchen,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 L.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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> r 7 PERMIT#/ �20DI _ D I(�1, 1 <br /> Owner/Authoriz Agent Signature �D�Z G (Revised 4115/2f11g) lb _ <br />