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111.111 PERMIT APPLIC • ► <br /> BUILDilk I MECHANICAL/PLUMBING M` /SPRINKLER/DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SE`VICES <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: 9®� N g,, e,y2/ Ave _PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: -TAe,4yN" CL O TENANT BUSINESS NAME(Commercial): 13vnaelkkty i 4al,b <br /> OWNER MAILING ADDRESS: STREET Qpy N 13icaTiL..0)/ /JQ IF A <br /> CITY 1n6ye STATE LOA_ ZIP 98�I <br /> OWNER PHONE: 42S_773.-- sl 64 OWNER EMAIL: j,,/pC�(AS 0367 no-tr. corn / <br /> CONTRACTOR NAME: 5 ) S / <br /> CONTRACTOR ADDRESS: STREET /9/4 Ht,y 9e A <br /> CITY Ly`lnVl L ,i % STATE Y11 a� ZIP 96 b <br /> CONTRACTOR PHONE: 'is--77 � <br /> 3� pp 7)- CONTRACTOR EMAIL:5C y >i0�� , Gays. <br /> CONTRACTOR LICENSE#(REQUIRED)):5' —DS* 96_(-313 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5-392_0 <br /> PRIMARY CONTACT: in OWNER t /CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4)-c-_ 273 ®onp� <br /> _T <br /> . A V11PS WV CONTACT EMAIL: �-� �S.�,s 4_� / Oo, r <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Wo • <br /> Proposed Use of Building: Heat Source: I] s DElectric OOther <br /> BUILDING USE: DSFR OTownhouse ❑Duplex DADU ❑Multi-Family-#Units: Accessory Structure <br /> Type of Project: ONew OAddition ORemodel ❑Repair DT.I. kiign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> YOS-f-A a C}44"0-e S t— S kia 1) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Flxmis Fixture Fbrture <br /> Count List of Fixtures Foam List of Fixtures Count List of Fixtures Court List of Fixtures <br /> NC-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 Dishwasher _Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration `Drinking Fountain Sink-Utility,laundry,mop <br /> r Exhaust Fans(Residential) Commercial Ventilator 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 Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other. <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System J No.of Heads - <br /> ACKNOWLEDGEMENT::!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 for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PER <br /> Thc--------------- i----0— .).1Q, 2.00 —CO Z <br /> Owner/Aut ze Agent Signature Date (Revised 10/10/2018) l/ <br /> Gz- <br />