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0 PERMIT APPLICATION <br />EVER TT <br />wAI WN "SON <br />BUILDING I MECHANICAL i PLUMBING / SIGN / SPRINKLER i DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET. EVERETT. WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov ! www.everettwa.gov/permits <br />Bate or BI=k it* Only Please SITE INFORMATION <br />LPROJECT <br />PROJECT SITE ADDRESS: I SI -2 wal Kwt, M-. e�Kxtft wvk . 916� 1 <br />PROPERTY TAX #: OoL435-7 3 1 L4oc <br />LEGAL for new constntGtion: Short Plat/subdivision i1}�v�l_ Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: sTREEE <br />crry W � ," �S2O <br />OWNER PHONE: 3 Coo'- (0S9 -O <br />1., <br />OWNER EMAIL: C► vto rJ S • LU <br />CONTRACTOR NAME: S� <br />CONTRACTOR ADDRESS: STREET <br />aTY s -7 <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: KOWNER ❑ CON TOR ❑ OTHER (Please Specify) <br />CONTACT NAMk <br />V 0. u�►QS - � f�mu�`iP� <br />CONTACT PHONE: 3(,p - I6V—O4OL-f <br />CONTACT EMAIL: `L'f(tlpyv.QSotJJS . Cc� r, <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />�i <br />Proposed Use of Building:Heat <br />Source: ❑Gas ($Electric ❑Other <br />BUILDING USE: ❑SFR []Townhouse ❑Duplex ❑ADU ❑Muff; -Family- # Units: ❑Commercial PL4ccessiaryStructure <br />Type of Project: ❑New ❑Addition ❑Remodel []Repair ❑T.;. [:]Sign._ ❑Sprinkler 1413emolition OChange of Use <br />DESCRIPTION OF WORK: -rbM0` `��� d.� `wo &kt_ <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fa <br />count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C - Air Handling Units <br />Gas Piping <br />Backflow Preventer (inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp, prep, floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen.bath.bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility laundry: mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Pipin2 Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-SandfOii <br />Water Service (behind meter) <br />Forced Air Systems <br />I <br />10ther <br />IMedical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />I <br />I <br />IRoof Drains <br />Water Heater <br />SPRINKLER 1 SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System I <br />JN6. 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 authonzed 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 Conhactors Law 18.27 RCW and 298-200A WAC <br />11 City of Evereif Oltickv Use Only <br />9 -7 -LoZO PER !T <br />