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MI PERMIT APPLICATION <br /> 1112 <br /> BUILDINGIDECHANICAL/ PLUMBING /SIGN I�2INKLER/ 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:ice 2 3 Pohl t'te T'��JJ',-L Id AY PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: • MCkyl.(4.1L - ..ebet---/ 17 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET iog's) I7A,jpla -C .e.1 tvl-y' <br /> CITY biZ & 1 STATE L4/ ZIP 9iZo if <br /> OWNER PHONE: ZOG 36c( 3 pD S- OWNER EMAIL: e.'t,awi C reseki !,� -,Z4(M1. cO0-+ <br /> CONTRACTOR NAME: <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: gOWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: /��`�, CONTACT PHONE: 206 36 er 3C>c59 <br /> FA4A(gVll L (,'`--6-e, CONTACT EMAIL: eenc. ri e.'/.ZLevl 6 6-J'ptpttr[. Gam'" <br /> BUILDING INFORMATION <br /> Existing Use of Building: {(-f' s rZ, Contract Price of Work:$ It 54,D619 <br /> Proposed Use of Building: no C4 of KA 5.r12. Heat Source: ZGas DElectric DOther <br /> BUILDING USE: JISFR ❑Townhouse ❑Duplex DADU 0 Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ❑New DAddition gRemodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑DDemolliittion DChange of Use <br /> DESCRIPTION OF WORK: T."►en'or €e +R-•-o2 a 1 O4- e1(.[s rG 4 Sf elite .C-0, t I p- 5+18.QGI64- <br /> 0 c.li,ats Sy's6- I Tt,9 H Iv• 9 A r 1- <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 /> I NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Z Shower,Tub,or.Ccvnbo <br /> Boiler Gas Range 1 Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> I, Clothes Dryer Heat Pump&Ductless I Dishwasher '5 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remode Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential)I Commercial Ventilation Floor Drain 't Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb 41 1 Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease , �' Waste/Water Piping Repair <br /> I Exhau� ood(Residential) Wood Stove Interceptor-Sand/Oil ( u Water Service(behind meter) <br /> FgrGed Air Systems Other: Medical Gas .,-,or ' Water Valves or Fixtures <br /> /bias Fireplace/Insert/Log Roof Drains r'J 1 Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Eje, or 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 to Contractors Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> 3-/0-7� T 6 Qj Oa, <br /> Owner/ horized Agent Signature Date (Revised 4/15/2019) 0.1)..j) <br />