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Irs PERMIT APPLICATIO <br /> BUILDINOIVIECHANICAL / PLUMBING /SIG 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 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue orBlack Ink Only Please). PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 31 1.S" Oft146-5 AVQ C, PROPERTY TAX#: QO52.rboo(oo j2( <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> - 'CONTACT INFORMATION <br /> OWNER NAME: -roD i/i.,1„0(4c/ftQ16 Rolf TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 5130 EijetWitAi _.j AY <br /> ep <br /> cn ' ev0-e)r STATE t�/A- ZIP _ C 3 <br /> OWNER PHONE: la S-141-6597 OWNER EMAIL:Tv(1Q8uLlouc°,6pvSW4.0clitr.O26" <br /> CONTRACTOR NAME: KKELT* guLtAAL ,,n coNS v va'W ,UUATE5 <br /> CONTRACTOR ADDRESS: STREET 3110 {�tr�rT' It✓Lf <br /> CITY EVeIT STATE `f- ZIP V01 <br /> CONTRACTOR PHONE: 'OS%t{3).-JLjL CONTRACTOR EMAIL:/( / LL g lu iedwaNS?RUG7't6NM�S- <br /> CONTRACTOR LICENSE#(REQUIRED):PtUXEC-Pt7O'DF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):3743.1 <br /> PRIMARY CONTACT: ❑OWNER 64CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> (*M- kG1.14.c. CONTACT EMAIL: i(j it Pc C.ALUMCPNg1zvcrlOADief <br /> BUILDING INFORMATION 7/� <br /> Existing Use of Building:MU(,T -Pf\iU-'( Contract Price of Work:$ t! cc (/ <br /> Proposed Use of Building: *lg. Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ElDuplex ❑ADU [Multi-Family-#Units: 30 ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler ❑Demolition EChange of Use <br /> DESCRIPTION OF WORK: <br /> f SAT t0.00M TO TNT Cavitw,✓(TY P.-oOM, coNil cr ry alsri, 6 Vn,UT(E5. <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 Fixtu Count List of Fixtures Count Li • Fixtures <br /> A/C—Air Handling Units - Gas Pipi Backflow Preventer(Inside Bldg) Show- , ub,or Combo <br /> Boiler • Gas .nge Clothes Washer ' -Commercial(3-comp,prep,floor)_ <br /> Clothes Dryer -at 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 I Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(R-• .ential) Wood Stove Interceptor-San. •il Water Service(behind meter) <br /> Forced Air Sy -ms Other: Medical G.. Water Valves or Fixtures <br /> Gas Firepl. a/Insert/Log Roof' .ins Water Heater <br /> SPRIN ER/SUPPRESSION SYSTEM sewage Ejector or Sump Pump Other: <br /> Water Suppres- in System No.of Heads <br /> Chemical S .pression System I INo,of Heads f <br /> ACKNO EDGEMENT: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 /> V3/3-O 2ent Si 002 <br /> Owner/Authorized A r <br /> g gnatu a e (Revised 10/10/2018) <br /> ' <br />