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PERMIT APPLIC: ,i 0�in <br /> BUILDIN MECHANICAL/PLUMBING0:10., -PRINKLER/DEMOLITION <br /> EVERETT CITY OF EVERETT PERMITS , ES <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 Block Ink Only Plowss) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2'OS y7yrad ti/ y PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: .2CF 41? ewva=27 TENANT BUSINESS NAME(Commercial): t 7vz re,/ <br /> OWNER MAILING ADDRESS: STREET y�)4' 5- (3mid W A/ <br /> CITY �' +, �V STATE 1.. ZIP ?al()) <br /> OWNER PHONE: '"t- 773 ---`✓L�a U OWNER EMAIL: K� <br /> CONTRACTOR NAME: -Sf / S' <br /> CONTRACTOR ADDRESS: STREET <br /> / <br /> CITY 1.7nyn,16001 STATE ', p�- ZIP g?o 3 6 <br /> CONTRACTOR PHONE: 42r-.�7?_—c c 72_ CONTRACTOR EMAIL: S7� yVs'j S4_A / "1,t . Cefr <br /> CONTRACTOR LICENSE#(REQUIRED)::� f2 .. rr —� CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): 93720 <br /> PRIMARY CONTACT: ❑OWNER t�J CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 44 5- 7....7? 009 <br /> tJ a er py,_ CONTACT EMAIL: $A0,<,1?YIS 4_ / iL,GD• CD`Yh <br /> ,BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$_ - l'7\17 <br /> Proposed Use of Building: Heat Source: DGas ❑Electric OOther <br /> BUILDING USE: OSFR DTownhouse ODuplex DADU DMulti-Family-#Units: OCommercial DAccessory Structure <br /> Type of Project: DNew DAddition ❑Remodel DRepair DT.I. OSign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> -ri 5+C If (305( S-281,3 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> FJxture Ffzture Fixture Fixture <br /> Count List of Fixtures coupe 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 Drinki9 Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation 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 l No.of Heads <br /> ACKNOWLEDGEMENT*l 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 worts 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 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 /> 5 c5- )..,- <br /> Z— PER ` ` 2_-oo C9 <br /> Owner/Authorized Agent Signature Date / (Revised 10/10/2018) ' <br /> 4_ <br />