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• PE- ATION 411/ <br /> 121 BUILDING/MECHANICAL/ ,�1 SIGN/SPRINKLER/DEMOLITION <br /> EVERETT CITY OF TT 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 <br /> PROJECT SITE ADDRESS: 9.1 I 1 .7Ftcksoo 1/n cc, Ue.vG I ; 1-.J Pr PROPERTY TAX#: 00 '1 S-60 `LOX)00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Rd\C 6-A.kn . TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTreEEr 3 r .P ( 1 s-‘.. 0 e <br /> cny TA Otis,sSAN.Z, STATE W fl ZIP V a7 <br /> OWNER PHONE: LA.S.-',)-3 O'I Oi OWNER EMAIL: C }}4t.3q� 9.C� (.614441&-4 - 40e-�- <br /> CONTRACTOR NAME: 0 tks NC-4L.. V <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 1;thiocr Gtai '. CONTACT PHONE: „2.3\ 0k 01 <br /> v CONTACT EMAIL: 1y, c\e,_ 1 C. 6.612tC!1S't . rU e-T <br /> BUILDING INFORMATION <br /> ov <br /> Existing Use of Building: S F R Contract Price of Work:$ i'/coo <br /> Proposed Use of Building: J F ck Heat Source: IJGas IE1/Electric DOther <br /> BUILDING USE:B(FR OTownhouse Daupiex OADU OMulti-Family-#Units: OConirnercial DAccessory Structure <br /> Type of Project ONew DAddition Remodel DRepair OT.I_ DSign DSprinkler DDemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> urckeke. eats w— c)it,.......\%v.te3 3- r .vtc../11/4ACrik" k?`( \.• CRDLA,ZkA4ICP44.5.-t"siS <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIO <br /> Count <br /> AxI xture adore Fixture <br /> List of Fixtures Count <br /> List of Fixtures List of Fixtures Count "st of Fixtures <br /> NC-Air Handling Units Gas Piping :ackflow Preventer(Inside Bldg) r ,Tub,or Combo <br /> Boiler Gas Range 1 C•'.es Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless i r ,.', =r Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking main Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain 3, Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) a Hose Bibb Urinal <br /> Exhaust Hood(Type II) 1 Water Heater Interceptor --.. / Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove IntuiuuptorS Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical .� Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof I :ins c57 Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM -ge Ejector or Sump Pump Other. <br /> Water Suppression System No.of Heads - 7 V <br /> Chemical Suppression System a No.of Heads , , r <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 /> r:.' 1.--,kd A_. ..A <br /> nt Si nature �Ili atPal I TA.2ito3 - olq <br /> Owner/Authorized Dat Revised 10110 2018 Age 9 ( ) <br />