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— PERMIT APPLICATIOI. <br /> in <br /> BUILDING MECHANICAL / PLUMBING / SIGN PRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION c7 <br /> PROJECT SITE ADDRESS:((7 O ( 12,-t 1 5i 5. ., �jey�( i�ct PROPERTY TAX#: I%000 9 71 57 0 a <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: hjr7R 15 1A g 11 4-/R.E S TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET (12 9 `J0t -T 20) ill 5± <br /> CITY ✓v 477 1 V NO/ STATE V-- Si ZIP cf 0274 <br /> OWNER PHONE: f2 5e 11 ( 5 3 OWNER EMAIL G t/1 o v ) o S €'vn'( 5 f „ 60 vri <br /> CONTRACTOR NAME:' QekAAL--t_ j S,3 c- ? ..0 -CY <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRE : g5 CITY OF EVERETT BUSINESS LICENSE#(REQIiIR ) <br /> PRIMARY CONTACT: 0,OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: n CONTACT PHONE: 4 Z - 1± - A(-(r�S-3 <br /> 7C1 i 11 M A/ J U S CONTACT EMAIL: 13 vyl ck i) u joy' e w C:_,0 VUel <br /> BUILDING INFORMATION ��� <br /> Existing Use of Building: F j%(�f..) C seg.- Contract Price of Work:$�2(''' �� S�O <br /> Proposed Use of Building: l<EGJI 1)E)\IC� 5 f-1- Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE:j2KSFR ❑Townhouse El Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: KNew ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ra P1t(1c-- -- E x r 5T/ rJC ©�G K <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 /> 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 I 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 lam 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 /> \ 1 /1):4 _ / PERMIT <br /> y/1µ'rj�/' (//�/y,I1 ^ - D 0 <br /> 'Owner/Authorized gen Signature Date (Revised 4/15/2019) 1/2_ <br />