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ii <br /> • PERMIT APPLICATION <br /> ni <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN IRINKLER/ 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: 1 -We- ® .__ ,1/-I°__ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: OkiQ (4(6�L-1 TENANT BUSINESS NAME(Commercial): <br /> / <br /> OWNER MAILING ADDRESS: STREET (pC) �Dk zJ- ("J <br /> CITY ?(,s k1�.�( STATE tA/W ZIP"d�! e <br /> OWNER PHONE: qL6-1'i1d 1�J -5356 OWNER EMAIL: 1 11I�'l� Yf�( <br /> j� /l . � l� <br /> CONTRACTOR NAME: a1 ry' 11 S /Y` 2-Lc:- <br /> CONTRACTOR ADDRESS: s'REET PI9 Bc) 2 1 4f <br /> CITY/� At�Oa/ STATE / ZIP T�t3 <br /> rl <br /> CONTRACTOR PHONE: 2 L -5 3> G CONTRACTOR EMAIL: 4. Y f t 1 c�1 �(�//r CO _ p <br /> CONTRACTOR LICENSE#(REQUIRE : �CO <br /> � 31CITY OF EVERETT BUSINESS LICENSE it EQUIRE ): <br /> PRIMARY CONTACT: ElOWNER ili CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 4 i k/i.� f'-- j CONTACT PHONE: ii�Cj --cl� - 3 5j 6 <br /> I CONTACT EMAIL: ) ,.e_17 Q0"Lf 7.e arm,/, a /Lv <br /> BUILDING INFORMATION <br /> Existing Use of Building: 5 F-e-- Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: g"Gas ❑Electric DOther <br /> BUILDING USE: E1fB�SFR ❑Townhouse El Duplex DADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ❑New DAddition DRemodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Ch,��_ //1 angeeof Use <br /> � �-r,�cA�( off- �xr <br /> DESCRIPTION OF WORK: rs�G h®✓14� ��1 ��4's=- S <br /> cJ -.1rICoSt- t\ <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 '3 Gas Piping Backflow Preventer(Inside Bldg) 7 Shower,Tub,or Combo <br /> Boiler j Gas Range ( Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> l Clothes Dryer Heat Pump&Ductless ( Dishwasher k Sink-Residential(kitchen,bath,bar) <br /> 1 Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> 1j Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 3 Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) .. Hose Bibb Urinal <br /> Exhaust Hood(Type II) f Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> ( Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil 1 I Water Service(behind meter) <br /> i Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> I Gas Fireplace/Insert/Log Roof Drains I Water Heater <br /> SPRINKLER 1 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 aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PE IT# �1 <br /> OW/dif l7 J�J .�� CC _ <br /> l/l Owner/Authonature Date (Revised4/15/2019) <br /> � 1/7 _ <br />