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min PERMIT APPLICA <br /> lc <br /> BUILD. / MECHANICAL / PLUMBING /SIM- I SPRINKLER/ 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: ( I 0 d (Al iV 1 C' riv\( Ut (2 (Ai hY PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C t7Gc-Q K Ch— T TENANT BUSINESS NAME(Commercial): �,n 1 f p6v-t-(,4iv✓ <br /> OWNER MAILING ADDRESS: STREET ( O( W / 4 AA r I v\P U . e l✓J r>v-- <br /> CITY -NI f!{P STATE (A)A 1 ZIP I ll CCC��� <br /> -R j.0 1 <br /> OWNER PHONE: I 0 . 3�5 34J-3 OWNER EMAIL: LA) ^G 1.(vOtvv o; ( Q (O <br /> CONTRACTOR NAME: /1 WMQ_ t�l <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: OWNER ❑ CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: a v6 3?5- 34 D 3 <br /> E Ai. vIe_ (<0-,try o. <br /> . CONTACT EMAIL: t A c) liv c+ 0 k A"it^/ii,- ( • %a' <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ $ 7 Did. (1%) <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other_ <br /> BUILDING USE: ❑SFR ❑Townhouse C .Duplex ❑ADU 0 Multi-Family-#Units: Wommercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition Remodel ❑Repair ❑T.I. OSign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WO-K: <br /> .' i I - �"t2e4-4� S (GG2 t\4 ctIAes�- Y-0k <br /> ASSOCIATED BUILDING PERMIT#(if applicable . 1. (.53 6-s - O6 <br /> MECHANICAL PERMIT APPLIC ON PLUM G 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 /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> 5 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/InserULog 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 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 /> 1 / ( City of Everett Official Use Only <br /> ` (<'(n., 11 1t li (( c PERMIT /t' O IU1/� <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2C 19) l/ <br />