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46 <br /> ® PERMIT APPLICATIO <br /> 112 <br /> BUILDINECHANICAL I PLUMBING I SIGNNKLER/ 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: e G 1 r q 7- 0 5 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1 t�k TENANT BUSINESS NAME(Commercial): <br /> Q/ <br /> OWNER MAILING ADDRESS: STREET C�C' 1 1 � 0 p( 5 L <br /> CITYVA/C...4---Cfi— STATE ta/+ ZIP Ce Zee, <br /> OWNER PHONE: OWNER EMAIL: <br /> L� <br /> CONTRACTOR NAME: jy t,,, )• r eJ i'-,/l,11 ce-'1.4 c:r-- <br /> CONTRACTOR ADDRESS: STREET \ L{c( 7tIN /tt,- 1. � • �j <br /> CITY 9.ZG%- e__ STATE L,l"I <br /> / ZIP 9 Cl f••�J <br /> CONTRACTOR PHONE: 2,6 c., 17 4 0 i CONTRACTOR EMAIL: 5 (y vc,t v y y�o St.' 2/*&cyZ.,p, f . cO %- <br /> CONTRACTOR LICENSE#(REQUIRED) S/(I \2-,5 1(0 /ri i-t CITY OF EVERETT t3USINESSLICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: U G 2,3. 1] OC <br /> ii <br /> �61 e M-cda-i✓, . CONTACT EMAIL: 516"'le,:Y 1.ri 5_,--,•cieV cp.Yar ,,64y`— <br /> BUILDING'INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ q, 31)1) <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU OMulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Teets- 0* e2(d IL-1 I 1 h raw �- <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 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior 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 /> 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 properly 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 /> PERMI-r-ic ,lot ID- 11,n <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) <br />