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MIN • PERMIT APPLICATION. <br /> Ix <br /> BUILDING I MECHANICAL/PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 l FAX 425-257-8857 I(E)everetteps@everettwa_gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Mass) PROJECT SITE R INFORMATION <br /> PROJECT SITE ADDRESS: 2A 5 130 Y n Ave. E V e-of-c.4-�1�- )A- i e2OS PROPERTY TAX#: 0 0 0 312.5 d 0 0 0 `3-00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: U t t Se S S i e x r c,, V e.G TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET t I 1 2 L{t_ 5 8 -{4-% P v C. S E <br /> cir' S Tvo viQ'M i-510, STATE LA) A ZIP Cl8 2,1 <br /> t it <br /> OWNER PHONE: (2.53) 8 3- 11.-1181 OWNER EMAIL ex- O.S •iA)4 5r n.e I1 CO <br /> CONTRACTOR NAME: U t ti S eS £r e,'c Y`c` 1 e.0, <br /> CONTRACTOR ADDRESS: STREET IA R.-2 5 8 Ave_ SE <br /> CITY S \A a V\O rA,t J Ts. STATE y ZIP 9 8 2,14 <br /> CONTRACTOR PHONE: (253 ) 8 5.3-{R 1 CONTRACTOR EMAIL:S i e.,Y'col F.Va M i riD Li OD j.mci VC()In <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: f CONTACT PHONE: (2 53) 613_ 19 8 el <br /> U \i.'SC._S S Te`lYlt V e ,,reN CONTACT EMAIL:5 1-eTY0,. cY,,,,rA.i. lti Rjr.„lcna 1. Go►'vx <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR []Townhouse Aupiex DADU ❑Multi-Family-#Units: []Commercial DAccessory Structure <br /> Type of Project: [ New DAddition DRemodel DRepair ©T.1. DSign OSprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: ` <br /> 1 N d of iv e,r ?e,Y tr+fi-c 4- -(x ram\5 i"G'( <br /> Pel> C-4- U d-1- c. -8 c. \E3 v.3 --00 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> IMMIMMINIIIM <br /> FD1ture List of Fixtures "" List of Fixtures Fixture List of Fixtures Fixture List of Fixtures <br /> Count Count Count Count <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 WasteNVater 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 Chemical Suppression System I INo.of Heads <br /> No.of Heads . <br /> ACKNOWLEDGEMENT:!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 /> Buikling Official before being authorized under any circumstance lam the owner,or l 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 298.2100A WAC. <br /> s City of Everett Official Use Only <br /> PE IT# <br /> (ti Sia- '--C50 ( <br /> Own rtAuthorized Agent Signature to (Revised 10/10 2018) <br />