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� PERMIT APPLICATIO. <br /> ral <br /> BUILDING'�MECHANICAL/ PLUMBING /SIGN ,SPRINKLER I 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: L/ 33 G /-1,;,./ 41/6, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Q piS.--f-csi vi t."t'O bt TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET .-3 3 1 67e Lie✓// 9/(Jei <br /> CITY ED c-,{,e / STATE /,(JQ S A . ZIP 9 C.) <br /> OWNER PHONE: L/Z S - Eg, . 5 L/SS ) OWNER EMAIL: f-0. m 5 4 Gf yl co Yd j6 (d_e.0 0')ci l 4 CCU kei <br /> CONTRACTOR NAME: 5a i^"E / C w n e✓ <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: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: / o CONTACT PHONE: Lj12 5 - 6 S ._5-4//c- / <br /> O r h t i✓(Cif CONTACT EMAIL: 7 0 iYJ 5 �U I^ i tv✓C.4 <br /> Q O `Ji. t 1,rd,.. <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ alO Do D <br /> Proposed Use of Building: Heat Source: JGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ,Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ( ddition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: add t z.,01 (y;) G a4 ,.c..z cJes — j L//)( 31 r becJ ✓Ovy1 s // CI4 Zij <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-Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units 2 Gas Piping Backflow Preventer(Inside Bldg) L- Shower,Tub,or Combo <br /> Boiler Gas Range -2 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 /> 2 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) .,,i Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> ,2 ForcE d Air Systems Other: Medical Gas t-{ Water Valves or Fixtures <br /> Gas Fireplace/InserULog Li Roof Drains '2 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 /> City of Everett Official Use Only <br /> / <br /> PERMIT# I ,1 ,^ J O 4� <br /> �A O C�l�' U <br /> Ow er/Authorized Age Signature Dat (Revised 4/15/2019) <br />