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® PERMIT APPLICATION <br /> az <br /> BUILDING.ECHANICAL/ PLUMBING / SIGN WINKLER/ 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) <br /> r� PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: i,�I�t2�i $.•,,19A1Z4 pg.. cc 1 Q 'ZO I PROPERTY TAX#:� 041- OO '0,;'o0 <br /> LEGAL for new cei ctlegShgtINt/SuG f+#fs16n� E gar P> Ldf No� att'3c'h copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: MDIr. -ems p-,04' i./4t (GU l-0v arAinli TENANT BUSINESS NAME(Commercial): JVpr <br /> OWNER MAILING ADDRESS: STREET 10 V; (. e 1 1`- h� / �y �y n 2 <br /> ittl*►4- t CITY STATE I�tW(� ZIP �I®"L0 <br /> OWNER PHONE: 4116 271 S i 444 OWNER EMAIL: Tl4 -174 X?t-G a a MM.-.Cz <br /> CONTRACTOR NAME: 1? PA PeXeri-M4 106 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR I3,OTHER(Please Specify) t 6k - --. <br /> CONTACT NAME: • CONTACT PHONE: 2 66 4 Z? 36 Zh <br /> CONTACT EMAIL: uAL1 e4V'TEµ 4> (%F?AiJT(ei'L .(meµ <br /> BUILDING INFORMATION <br /> Existing Use of Building: �7 1Z Contract Price of Work: $ 10i 1C:)0• <br /> C7 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ,SFR ❑Townhouse El Duplex DADU ❑Multi-Family-#Units: _ ❑Commercial DAccessory Structure <br /> Type of Project: ❑New DAddition 0 Remodel ;Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1ze_piri . prj-Ul7 P712-0N4 IJP 117 CDPPi prLb9g(Zgy VIc L-! cric5►J 40 - <br /> GKse, G . lq- 011¢ i v,1S4'cc °rec.k- tAtO.,sr oP' irousE1 1.X15.1 ie. GPitz PD(a " 4 <br /> vi-Da$g Goµ t4P-crioN TD 4A-419aR.T• <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 12. Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> 1 Exhaust Fans(Residential) Commercial Ventilation Floor Drain IZ. 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/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Othe.--)--r'*--- <br /> Water Suppression System No.of Heads ,Z..✓ eet-oc4k1T N 4 <br /> Chemical Suppression System No.of Heads S1 rU 0-1- <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done purs.i rrrro s permit <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 /> City of Everett Official Use Only <br /> PERMIT# <br /> c/L-Jk -- SI ei ig <br /> a CO ICI,OS .--°° ( <br /> Owner/Aut rized Agent Signature Date (Revised 4/15/2019) <br /> k/Z <br />