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IIM PERMIT APPLICATION <br /> BUILDING MECHANICAL/ PLUMBING / SIGN 0PRINKLER/ 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: 2, 130 li a Lka/ 4-01: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION r. <br /> r f— TENANT BUSINESS NAME i <br /> Commercal . iOWNER NAME: �j, � 1�r � �vl �cJ��.t-rr. ( A L2 .c- <br /> /� <br /> OWNER MAILING ADDRESS: STREET Z 1 U I� 1�,_h t/'' A cif-- OcAt.. <br /> CITY /i� vc t ft STATE G✓A- ZIP <br /> OWNER PHONE:— 252 3/y/ OWNER EMAIL: <br /> CONTRACTOR NAME: ,C h icy R o c 6 •1 <br /> CONTRACTOR ADDRESS: STREET /c p/Q — ' /�j .../71{15 /1).{ <br /> CITY W t1 CV) r) o f /4 STATE (ICJ T ZIP �Q 7.2_ <br /> CONTRACTOR PHONE: 7()6 —LS's—: 21 ),r CONTRACTOR EMAIL: f ,,,, (k, � , J 1z /, ,A _id rT <br /> CONTRACTOR LICENSE#(REQUIRED): jhfid t?R 37_fir 7' CITY OF EVERETT BUSINESS LICENSE#(REQUI ' : r InMMI <br /> PRIMARY CONTACT: 0 OWNER J4 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2 0 ) �J—_(—"-73 .7f— <br /> '�,, J 7 12 / ,Cy CONTACT EMAIL: (� <br /> / BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ (] )./D , o <br /> Proposed Use of Building: ,/& . ,./ Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. OSign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 3.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 /> 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 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 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 Everetta Official Use Only <br /> -D-e,- ' ✓ /�/5 PER# n°_ ` l <br /> (,„ <br /> Owner/Authorized Agent Signature Date (Revisedd-4V//115/2019) <br /> /Z <br />