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PERMIT APPLICATIO <br /> LI <br /> BUILDINOMECHANICAL I PLUMBING /SIGN . PRINKLER I 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)/ � PROJECT SITE INFORMATION <br /> FOORMATION <br /> PROJECT SITE ADDRESS: ( 7 fr �//A, tr j/eiu/ - toA PROPERTY TAX#:0OOf' yoays 3 OD <br /> LEGAL for new construction: Short Plat/subdivision I Lot No. (attach copy of long legal description) <br /> ONTACT INFORMATION <br /> CC <br /> OWNER NAME: / �t f- el v//Lc TENANT BUSINESS NAME(Commercial): <br /> 1 ,�JJ <br /> OWNER MAILING ADDRESS: STREET 33 /p�/ J G , / IV J C�1,{n 7 <br /> CITY 5 r v 0 U STATE W /1 ZIP C rr C 12 <br /> OWNER PHONE: OWNER EMAIL: <br /> `7 CONTRACTOR NAME: kg/S ( iCC tt'L.S ovl <br /> CONTRACTOR ADDRESS: / STREET 'z g 2j 3 1 g , so' P1 N w <br /> CITY 5,J(/t.,„W 00( STATE L1� /4- ZIP W 2 ' <br /> CONTRACTOR PHONE: j (v 'C' j f ' 5 ! Q/ CONTRACTOR�/ J EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED) -T2ie rZ q': OF/ - CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �3 t 1 7- <br /> PRIMARY CONTACT: 0 OWNER ❑ NTRACTOR 0 OTHER(Please Specify) <br /> CONTACT ME: CONTACT PHONE: 6 Q ? /7 /7 <br /> N <br /> 711 & CONTACT EMAIL: 44i L,t_4 P5 yq..c ( ,; p.,tr..1(, cv,,,5 <br /> BUILDING INFORMATION <br /> Existing Use of Building: I n 3 5 c. Contract Price of Work:$ 'l/ 60'6 <br /> Proposed Use of Building: Heat Source: OGas Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex :VDU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Q po _ �� G�//� j € /�4,/�OG� o f lilac <br /> ‘,( <br /> f v-GL© 50r �ja2"Jae A (/"I ,,/n 1r� 'tt' / 6`'�� <br /> c!�reofi-i'4"[J d I !"`G-)7e-�`- be- r- W tcl0 O - °C)2 <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) 6 Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher 2 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain 1 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 /> 1 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/InserULog Roof Drains Water Heater <br /> SPRINKLER/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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and I c mp with the State Contractors Law 18 7 RCW and 296.200A WAC. <br /> City <br /> yoo�f Everett Official Use Only <br /> 2 ? � L� / l P EMIT# \ to on r ' <br /> O ner/Authorized Agent Signature Date (Reviserdd4/1)5/20119) <br /> I/2_ <br />