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EMI PERMIT APPLICATION <br /> IASI <br /> BUILDING/MECHAAL/PLUMBING/SIGN/SPRINKLER/DF JTION <br /> E V E R E T T '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 /> (sli+ 4011100 O ). t h PROJECT S rTE INFORMATIOnt .. . . . <br /> PROJECT SITE ADDRESS: 3$19 vs) Allt6k-kto Blvd E\lu f.+r erg7031PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description) <br /> a ,._ .. cONTACTINFORMATre <br /> OWNER NAME: Lis( Uik.—% TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRES;StIgsTREET W ittVic.\Cf{t7 IC3144 <br /> CITY ,1^V2(&AA- STATE lift ZIP `iISZ63 <br /> OWNER PHONE: 20(0 S11 7SCD OWNER EMAIL: liScte, PLO w 1.3\, Corn <br /> CONTRACTOR NAME: S-1'GV•C i S ?I U tttL t✓1 $V Ebb l olbe4 <br /> CONTRACTOR ADDRESS: STREET sras 7ei("-i-, 5-1- 51V4e_. 12(p QQ <br /> CITY Lynn IJ1) A STATE 0i ZIP -($0n <br /> CONTRACTOR PHONE: tits-Z.-IS- 11Z5- _CONTRACTOR EMAIL:S.1.e.w.A ItOwibin @ t oistCG'iS'f,jLo l- <br /> CONTRACTOR LICENSE#(REQUIFsr ?, CO o� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): tiq 3� <br /> PRIMARY CONTACT: ❑OWNER ErCONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1415 LIZ$ /641 <br /> .giY t al Q) 1C- CONTACT EMAIL:%kt.VeS1I vp, , Ai) 5-g 5 W(Gt I •Go"" <br /> 1 _>._ ., .. -; _` ... w*:t sftkINI ORMA'>I I N <br /> Existing Use of Building:�� Contract Price of Work:$ U <br /> Proposed Use of Buil Heat Source: ()Gas DElectric OOther <br /> BUILDING USE: FR OTownhouse ODuplex OADU OMulti-Family-#Units: OCommercial OAccessory Structure <br /> Type of Project: ONew ition ORemod I ❑Repair OT.I, Sign OSprinkl r (Demo,lition Change of Use <br /> DESCRIPTION OF WORK: L.9�/ i t SA,--re)v)kr— vA I,t ) i v 4f/ OC° O <br /> (-7 Jt/.'6'--- 1-414/l, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> :MECI IANt•AL PE iMIT"APPWCATION ,- : PLUMBING ERMI'll"'1 PUCATION, <br /> Fixture fixture Fixture Fixture <br /> Count List of Fixtures count List of Fixtures Count List of Fixtures List of Fixtures <br /> Count <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(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 Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER 1SUPP.RRESSI0N SYSTEM. , Sewage Ejector or Sump Pump Other. <br /> Water Suppression System No.of Heads <br /> Chemical Suppressi e I No.of Heads <br /> ACKNO MENT:I h reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> cuneM ral, • -,and I l law.The gra of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Buildigg Olfi'.,1 be .re bei authorized;zing <br /> 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 /> and4 comp with t,e St Contractors(few 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Q p <br /> /) I ��% PERMIT# p1-� i •0 {�® <br /> Owner/Authorize. n''igna ' Date (Revised 10/10/2018) + <br />