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NM <br /> BUILDING• PERMIT APPLICATIONS <br /> / 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: / 6 to �i% vl"7xL L (,),4 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> C --- <br /> CONTACT INFORMATION <br /> OWNER NAME: R T 02/KLt.y C kJ" C§NANT BUSINESS NAME(Commer ' I): <br /> OWNER MAILING ADDRESS: STREET (le)[t0. 19G d( f)-14L1, a wr/ <br /> CITY STATE ZIP <br /> OWNER PHONE L4tj 5 © jZ_ OWNER EMAIL: <br /> CONTRACTOR NAME: �i,V'1 AJ S 1 iy)Ic 17 v 1( 2t 0 <br /> CONTRACTOR ADDRESS: STREET (6,91 in A �j� PD Ad ay <br /> %/k r '/mooWCITY STATE /1?//q6# ZIP Ci:S?g 3 <br /> CONTRACTOR PHONE: .Z -- zjc-t .'-?6'57-1 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED) rn t_Cf / CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):,,,m(p. <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NA IE: CONTACT PHONE: c"1 � . �t'`77-��• <br /> i/ i GZn ,LSD Py <br /> CONTACT EMAIL: 7i,Ns , / r:. RWI�GLL/aJC`2 %L. eient <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of W :$ / _c'b 6)) <br /> Proposed Use of Building: Heat Source: ❑Gas Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DAD El Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WO K: G / - (� ' �7 <br /> 'V"(c J ` i LL�� L " ".E 5 <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 /> NC—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 1 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 compl ith the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> /.- City of Everett Official Use Only <br /> T# <br /> rL03- 4"C-3=2 P9O J <br /> S . O� <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) <br />