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PERMIT APPLICATION <br /> ni <br /> BUILDIN MECHANICAL/ PLUMBING/SIGN aPRINKLER/ 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 /> (Bluie or Blank Ink,Only.Pleasle) : ...PROJECTTtSITE INFORMATIO;NN'x .,< ` z.,r . �'.,.,.. . . <br /> AfROJECT SITE ADDRESS: 6 107 D[�c/t f JV _ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> , CONft.Adtl:NFOR IIA►TIO +1 . e <br /> OWNER NAME: Get r,,,,AC-6 s' TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: a(:)CQ^ L(9 g-. (1;L5 <br /> CONTACT EMAIL: <br /> ,.,_;;,., ,....BNIL.D.ING INFOIiMA`T1ON . . <br /> Existing Use of Building: Contract Price of Work:$ —0•e-' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition El Remodel El Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:js /lct ( c+ /— %� Nin k,A it c�2tG , <br /> /c� Jril.Ci Q— <br /> A OC ED BUILDING PERMIT#(if applicable): <br /> ;. 1'. IiAM.AI PRRM_1T ApPLI 1TI.lN. , .PLIJMBI#,�'PEIt011RA PLICATI®r1_, . ,.,. . <br /> Fixture . Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> 4 NC—Air Handling Units Ir Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler a 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 /> Q. Forced-Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> ,,,; SPRINKLER I SUPPRESSION SYSTEM ` ,_Y__ 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.lam 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 /> A/ PERT T t L atI ©/ D[ W <br /> V r 1 <br /> O N u ized Agent Sign& Date (Revised 4/15/2019) <br />