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PERMIT APPLICATIOra <br /> BUILDINt ECHANICAL/ PLUMBING /SIGN ,WPRINKLER/ 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 /> PROJECT SITE ADDRESS: / 3 is PAC t F'G /`y v t PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: poTALA V?/lA?e //C TENANT BUSINESS NAME(Commercial): 2 QPI eA) A?/, <br /> OWNER MAILING ADDRESS: STREET /PPo Box 13,026 / <br /> `CITY V Yf€ t STATE ZIP T.E-a 06 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: g € C) /I/(.eckc✓I ►c4 r (N C <br /> CONTRACTOR ADDRESS: STREET 3 3 5 3 o / 5 T 6NAy E O. Sv 1 TT /o0Z <br /> CITY Fe 0 f of 1 GU i t/ STATE _1 ZIP 'ef O O3 <br /> CONTRACTOR PHONE: a 5 3—7J r 5—PA 0 171 /CONTRACTOR EMAIL: K b Ale C t c )CQM('A ST. NeT <br /> CONTRACTOR LICENSE#(REQUIRED): et)MeC i4O D I c-s- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: a S 3—9-4/..�—Fa 0 <br /> 171 <br /> S'A/VLe S 7 C Gl ('/ / CONTACT EMAIL: ,<i /t�e c t c? co tc4 si Nr� <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 416 0 O 0 <br /> Proposed Use of Building: Heat Source: OGas glElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ®Multi-Family-#Units: ZOO ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ®Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 4-MST4( ( /J"•.J &1-1,1(I. oit6 "7!cicTfrS ' •t ,fr fe,S OF et-it ,j <br /> e4.4pf{. C/p..i .t-'ST',f Dom(1,..ii• k go sr e 4,iI l3! IA-posed <br /> A D V c.r/ <-T f of Ai ?b //t&-,) &(1Z To I/14 v <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 /> NC—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 /> 3 Duct System(Remodel) Of Refrigeration Drinking 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/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System /) No.of Heads <br /> ACKNOWLEDGEM NT:I have rev" wed t sApplication and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,sta ,and local la . he a ing of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official b ore being au o led n r 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 wi the State C tr tor L w 18.27 RCW and 296.200A WAC. <br /> City of Everett Official <br /> JUse Only <br /> PERMIT ��Le\` b I <br /> / /yZ Z-Zo2v <br /> Ow / uthorized Ag t Signature Date (Revised /15/2019) k <br />