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Nor PERMIT 11 APPLICATIO <br /> BUILDING. ECHANICAL 1 PLUMBING/SIGN PRINKLER/DEMOLITION <br /> E V E R E,1' 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: (0(p 2-4 'axe, 6' Ua.(i�i lAft (r PROPERTY TAX#: . —?q.�, ; sLa0u <br /> LEGAL for new construction: Short Plat/subdivision Lot No.2_ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 12217s ue- 't(3+ Vt TENANT BUSINESS NAME(Commercial): al I,rj A Vt1DY)'(b f ive, <br /> OWNER MAILING ADDRESS: smEET (pp(�(�24 e r Wcti j q Q <br /> CITY IJLC J IU STATE WG( , nP O - <br /> OWNER PHONE: 4Z5 - OM -35 f 2 OWNER EMAIL: .L7 - i-tb 6,0( � 9�r�,n/tt (, C <br /> CONTRACTOR NAME: (�' <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): I gcZ <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (�.25 - ?J-l Gj -,3 �� <br /> CONTACT EMAIL: <br /> �� �Dsllh 6v �( S6 l . <br /> VT taia.Cc3r✓� <br /> BU DING INFORMATION <br /> Existing Use of Building: 676/7(L(e-A P, A2t -014.A-}-t.Imo. 0F't/(.1A Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: )6ommercial ❑Accessory Structure <br /> Type of Project: ❑New ddition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORic <br /> V[S ()F AA. od-Gy:.61 5-E-61,c_ GWt a 2 It11 nu 61L /,x-f-U r Yhad- <br /> p&v per' -4 M 200-7-U -7 a f ' )9714 Iss7 r- p (JIIas ii/iniel'eir <br /> ASSOCIATED BUILDING PERMIT#(if applicable): �1,- 2 d);:t A � ��y(.�IS Lq►-- 61i. `71 I )"D"') <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fndures 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 i5)j .P/44,4 y ..Q 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 I 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 fficial before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I ly with a State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> // 7 7 -.() PER \ --105 <br /> Owner tho Age nature Date (Revised 10/10/2018)� <br /> I/ <br /> 2- <br />