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• <br /> PERMIT APPLICAT • • <br /> BUILDING /MECHANICAL/PLUMBING/4110 SPRINKLER/DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT CES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 3 FAX 425-257-8857 3(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 'IR(q ✓E6 c,!2,e6.A./ v/A`! PROPERTY TAX#: aG��81 t L)000c <br /> LEGAL for new construction: Short Flat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: e 1 4&£M co_,}j vi c.t4 5 f fj r-t v 1- TENANT BUSINESS NAME(Commercial): Q 1 <br /> OWNER MAILING ADDRESS: STREET 115 6/ /\/O/1. -1-/ L,A/44 pA _ __ <br /> CITY G'/0J4-f LJ N4 T) STATE 0H' ZIP (-t, 2 L4 q <br /> OWNER PHONE: ,:-‘45Li 'Sg 4 01 OWNER EMAIL: IA <br /> CONTRACTOR NAME: 101!4n/aJ) (/v d./ , f.L- C <br /> CONTRACTOR ADDRESS: STREET I (3,T I-f `v i'" A.) i G <br /> CITY A✓&//.LAI STATE (A/4- ZIP '?2 e ) 1 <br /> CONTRACTOR PHONE: 2 5-3 -Q 8'7- 5gC.) R CONTRACTOR EMAIL: 4 S L. ,¢t(L c,A - J ( ) 6,44 4/L.CO'fr7 <br /> CONTRACTOR LICENSE#(REQUIRED): t4)SAD.)v G_2 3 D P CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(20 263359 7 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2_5 3 9$ '7 ,'Q o T <br /> S 460)—i 174,e L L V2_ CONTACT EMAIL: ✓'� <br /> BUILDING INFORMATION <br /> Existing Use of Building: G o w",E act A L Contract Price of Work:$ 04,0 v <br /> Proposed Use of Building: (I n L Heat Source: OGas DElectric DOther h1 <br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex EJADU ❑Multi-Family-#Units: ECommercial OAccessory Structure <br /> Type of Project: [New ❑Addition ❑Remodel ❑Repair OT.I. *Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: / <br /> /�16r4I eM.g- ,L��/it^I.+./rtre47 1i,/ALL 6/&/ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture „re Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count 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 /> Exhaust Fans(Residential) Commercial Ventilatior 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 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.lam the owner,or lam 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 /> PERMIT# 1 �y \f <br /> (�11 <br /> Own rized Agent Signature Date (Revised 10/10/2018) <br />