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PERMIT APPLICATION) <br /> ILE <br /> BUILDIN ECHANICAL/ PLUMBING /SIGN 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: t © a._ ' L I ck'' j\vi^ S.E. • 5 u u 1�cr L ® , PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Stl,V ,I cin% YPtMi4f4v Gtrk I TENANT BUSINESS NAME(Commercial): e,E(Z 11(\ME Lo,NJ c <br /> OWNER MAILING ADDRESS: STREET 6 S y 3 S O . 3 0,..xe..k J , A <br /> CITY I i-Q,'� r') STATE C 2- ZIP O 5 6 q 5` 17 2-I <br /> OWNER PHONE: gas " -- SS S "` 'i 3 OWNER EMAIL: ( 1 1-k 0\u e. de,(N i-,\ e e_e)na c 0,S 1-7, ri e- - <br /> CONTRACTOR NAME:iii C I"'cc rc c c) S C1 N <br /> CONTRACTOR ADDRESS: STREET t(,A 0 63 —74L, 1 L,__ V.1 1 }}j U/, <br /> CITY Li f\tOw e STATE VU./v %' ZIP � 3 7 <br /> CONTRACTOR PHONE: '2S - y l ck\1 Ti <br /> 11 CONTRACTOR� EMAIL: c' (I3 O\(1 CC(ISS rb c r 41 C,o,..` <br /> CONTRACTOR LICENSE#(REQUIRED): C Iw S SS* C co tin 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t)\j pr <br /> PRIMARY CONTACT: ❑OWNER PrCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: � CONTACT PHONE: 9 a$ —\,;I c6 t - (A 4 1.\ <br /> _t. 0. l,` <br /> !� C) , A---e) CONTACT EMAIL: 1?f A 1 J C_C CAS: t 15 1 qR,Co Ate! <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:f. Co 00 <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. (,i Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: i,‘s 1.,4‘. <br /> .�-/�S�"'r. �t S- <br /> � * � °v`-Q,, �o-��"S .1`0�� dGo►'r a� ILL_ �t3� .S1yt <br /> ASSOCIATED BUILDING PERMIT#(if applicable): J <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 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 I 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.lam 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 ith the State Contractors Law 18,27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> i —3/ 3J ) PERMI2-(90.-r7—005 <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br /> ``Z <br />