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Emi- PERMIT APPLICATION <br /> BUILDING t ECHANICAL / PLUMBING / SIGN RINKLER/ 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 4/3 q ioa d tit/ay PROPERTY TAX#: Oc) -(j f/ 7c)/ .3)0 <br /> /%U <br /> LEGAL for new construction: Short Plat/subdivision (✓elf '/Gt/'67e/k J` '7 Lot No. '-( (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET cz? L/05-- 7ySue(it/(L,/ <br /> CITY �v v' / STATE ✓1„ /1 ZP ! i 0 1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: GT✓..Ztn lj�./1 <br /> CONTRACTOR ADDRESS: STREET 5-41'n 1� . <br /> CITY 5 •e STATE v/41-- ZIP 7 /J5 <br /> CONTRACTOR PHONE:)`J6-,,/4j-4,„)._7 CONTRACTOR EMAIL: �i/Ze L )71-..-G1Y3t'4 L'f -G`2t'i1 <br /> CONTRACTOR LICENSE#(REQUIRED): A E�(5G ‘, .1 vi CITY OF EVERETT BUSINESS LICENSE#(REQU ED): <br /> g . op___Te) <br /> PRIMARY CONTACT: ��`` <br /> 0 OWNER CONTRACTOR WTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �0L_ (( ?-l it7G/ <br /> 4( 7, L G; CONTACT EMAIL: & c-,,/eGtt,- (A,/G-)/P-co`-.11 <br /> BUILDING INFORMATION <br /> Existing Use of Building: v1./cv:el- Contract Price of Work:$3 D OD <br /> Proposed Use of Building: Gt✓z Gey/ Heat Source: 'Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse El Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: �p <br /> �1_61/ i r tth Ik- t LA 00 A EG i41v w/1 2- cJ/4-S5 6-(oui <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 /> 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) I 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/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 /> �, /��/67 ,� m �,okUU , nil <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) / <br /> Z <br />