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— PERMIT APPLICATIO <br /> LI <br /> BUILDINECHANICAL I PLUMBING / SIGN s PRINKLER 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: 13(L7 (y d-L Si-- ,S,(,t, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,\I sZWD.L y 0„t,4-✓C1 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: ( STREET L 7 ZO Ste` A-(/i ( ;, (� <br /> CITY �/-t(/�,4.77' STATE C.-Lk ZIP 9'12 S <br /> OWNER PHONE: `(Z 5- 3� ! YS 3 5- OWNER EMAIL: <br /> CONTRACTOR NAME: 542_c,44-[4 CI y U ,ti-11,tiij Gti.A 1- -eci L(_' <br /> CONTRACTOR ADDRESS: STREET 9/ .` Y 4` j i_ <br /> CITY PIA ,I(['/jav STATE Z 7 <br /> hi; ZIP 7.6 <br /> CONTRACTOR PHONE: Y a j-i o.S O y©3 CONTRACTOR EMAIL: Sam 7,r 6-i l"/lwaia b(r5Gwj✓l{fit k-x„ C4)6 yi'/ :/-( <br /> CONTRACTOR LICENSE#(REQUIRED): Sec,Wee ,S�?'( i L CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): "ip0Z,62(0 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) --Ytti4...----.--' <br /> CONTACT NAME: CONTACT PHONE: z(Z S_Ct p c,0 kis <br /> JD4o1. vi �F,l,lc jcui,- CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work: $ 3 S YS <br /> Proposed Use of Building: R....,2%;iavvVj t,I Heat Source: EIGas ❑Electric ❑Other <br /> BUILDING USE: /1SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: CI New ❑Addition piRemodel ❑Repair ❑T.I. ❑Sig/n/ ❑Sprinkler ❑Demolition ❑IChange(ofUse <br /> DESCRIPTION OF WORK: S�-}-tot I,e,}-✓ So-4- I/I Ee I- K•.�-c„,, S h 4 I S ,1- h h <br /> LC.c/csCw �� w�,i (1 / <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 2_0( i 2_ -cAs <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 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 I 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 l 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 Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump ( Other: L e-A L) S' ,,, <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System INo.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 /> PER IT S <br /> A <br /> 749-2o2 2-00 2 a <br /> Ow er/Authori d gent Signature Date (Revised 4/15/2019) <br />