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N PERMIT APPLICATIO N <br /> r ILI <br /> BUILDIN MECHANICAL/ PLUMBING /SIGN PRINKLER I 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:111\4 I U.QI/�- ? ( ' ) PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION p �2, <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): oaf, ��--"�" <br /> 66.7 <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: PoLtar1 .- vfieerJ) -?--_t; G <br /> CONTRACTOR ADDRESS: STREET `7 t="I 'He P- .1.ee--7 r'7.0 /3v <br /> CITY S.P,�> 10' STATE — ZIP1 `"? <br /> CONTRACTOR PHONE: 3ti,--7v 2--7 l!) CONTRACTOR EMAIL: O��jy� ,S� 7?j/4.., /4 y✓7e ,441 i..1G..�.,. <br /> CONTRACTOR LICENSE#(REQUIRED): P) (>Ar62 Y. ,►2 CITY OF EVERETT/ BUSINESS LICENSE#(REQUIRED):.(L4 ZJ <br /> PRIMARY CONTACT: 0 OWNER WONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3(�47 •— 14...,L—'7/ei— <br /> " /%• .e,1 c-z r CONTACT EMAIL: , 6e j �� , 0,-„ k G-,.1 <br /> BUILDING INFORMATION <br /> Existing Use of Building: ` iet /..4 Contract Price of Work:$ zJ.l.>' <br /> Proposed Use of Building: 67 4..4Z.3 Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Or ommercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair t 4? ❑Sign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <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) 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 /> 11 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 /> n City of Everett Official Use Only) <br /> /42r2�3 PERMIT1 I� V�.' �j (/ <br /> r/A ed Agent Signature Date (Revised 4/15/2019) 1/2_ <br />