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_ , • • <br /> PERMIT APPLICATION <br /> IN <br /> BUILDING /MECHANICAL/PLUMBING/SIGN 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 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2-4 I'D - 3 8-1-14 G-4 , PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: -.CipiN bt LA totA-- fi- it TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 2.Li I C.) -- -,5R'HA St" v <br /> CITY .ti'L.,1-4aLC,rr: STATE bill • ZIP <br /> OWNER PHONE:(-11-TD F2*-- 7,506) OWNER EMAIL: <br /> CONTRACTOR NAME: Cve,-...gavw.eA,...] Siv--re, 241-&-9tr e AC <br /> CONTRACTOR ADDRESS: STREET 2_1.2_0 IA-c_Lk.tc- . <br /> CITY -Et//..2Crr STATE IAA . <br /> CONTRACTOR PHONE: (C12._.0 2.92 -3//t71" CONTRACTOR EMAIL: le e/7 62-62,5'S'll ttja.. ci 0 CONTRACTOR <br /> - <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> — <br /> PRIMARY CONTACT: El OWNER CONTRACTOR 1:1 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (L1 2_s) 6-0 8; <br /> 14-0-k) gcrt-e) CONTACT EMAIL: g.e 4-1 Q I-2 15. )0 4.../4,, aogat <br /> BUILDING INFORMATION <br /> r) ob <br /> Existin9 Use of Building: Contract Price of Work:$ 50c../ <br /> Proposed Use of Building: Heat Source: OGas 0Electric °Other <br /> BUILDING USE: OSFR OTownhouse ODuplex HADU LiMulti-Family-it Units: I:Acommercial DAccessory Structure <br /> Type of Project ONew OAddition ORemodel ORepair DTI OSign OSprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: Ti.:37.141.1....._ 101.,171.,) Fie.e.-1, 5 Li/4 t 7— H-04-177 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> - <br /> Fixture Fixture Fixture Fixture <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Count Count Count Count <br /> NC-Air Handling Units I 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 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/Insert/Log i 1A9 i riftarr2-• 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 /> - <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.lam the owner,or lam authorized by the owner of this property to perform the work Aor which application is made, <br /> and!comply with the State Contractors Low 18,27 RCW and 298.200A WAG. <br /> City of Everett Official Use Only <br /> /, ! <br /> )21....‘,.. <br /> le-2 - (-e) <br /> [PERMIT iirin im 1 <br /> Owner/Authorized Agent Signature Date (Revised 10/0/2018) <br />