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mio PERMIT APPLICAT10111 <br /> 12 <br /> BUILDINIPMECHANICAL/ PLUMBING /SIGN i 'PRINKLER/ 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: ?,36 8 9 7 i4 ail Sif oi-_". 1-'f- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: I NL,, 4. CCAA t),UrTI0, 4 i)r 1N(, TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET (/ go/ 6 /V_C Z(1 to LC Oa_ 3 62 � ((/� <br /> hi /U- t/I�IJ(i IJL <br /> f CITY A _ STATE ZIP C ,, Z <br /> OWNER PHONE: , 6 % LI -7- Y Pt P. OWNER EMAIL: G(..f/'t/Jr vPc-},ItDTvu jm Q c.f4/4!L. cd,,..., <br /> CONTRACTOR NAME: S1404 A j- 0 Jv):- <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: IR OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ? O � ci`f 2 _ v S'i 8 <br /> CI-}T2(S i o i.J n CONTACT EMAIL: CN iits 7.o 4,N.,,„-D %awir l „4„,,,L..Ci;.^-I <br /> BUILDING INFORMATION <br /> Existing Use of Building: SF Contract Price of Work:$ <br /> Proposed Use of Building: ,St L Heat Source: ❑Gas piElectric DOther <br /> BUILDING USE: VISFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: El New DAddition `❑Remodel IEIRepair DTI. DSign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: _ , 1.150L/3La il L,v, -t ?t,`5 c <br /> - _ / — / <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture List of Fixtures Fixture List of Fixtures <br /> Count List of Fixtures Count List of Fixtures Count Count <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) 1_ 1 Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless l (,/ Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain 3 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 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> —s, P IT# <br /> -�� -7- 29—/ , k(A0q- - OC4)C( <br /> Owner/Authorized Agent Signature Date (Revis d 4/15/2019) <br />