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= PERMIT APPLICATIO <br /> BUILDING.ECHANICAL/ PLUMBING / SIGN RINKLER/ 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: 4 -] 2,e v� y1/(,4., NIA U u P4j Tali L PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: tl'c (` L \ V.:L.1er[ TENANT BUSINESS NAME(Commercial): (14.0 j.,�f'i �,`,� <br /> OWNER MAILING-ADDRESS: STREET 1 v- 13 a; - )5 L vi. &t9TCLZ 044 rgo i/ <br /> CITY STATE ZIP, <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: i r 1 t U <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ROWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206- 4-a 56 74 <br /> VI IR-r\ - A- 1kyrAs CONTACT EMAIL: <br /> ` <br /> BUILDING INFORMATION s,. — \ <br /> Existing Use of Building: Contract Price Work:$ '4 ow <br /> Proposed Use of Building: Alt 61-r,l„ j4PAS Heat Source: ❑Gas ❑Electric IDOther <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex DADU ❑Multi-Family-#Units: ommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair tr1.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Ft b ,vt3f(-+t Lv,.-.) 14 .`is -roc' r-F S.eRc-e <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture -'�1 Fixture Fixture <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Count Count Count Count <br /> A/C—Air Handling Units Gas#'iping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler 'as Range Clothes Washer Sink-Commercia (3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Resit lal(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sir1k,L1fi ity,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain ,—,toilet <br /> Exhaust Hood(Type)3' (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 Fir lace/InserULog Roof Drains y Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejr or Sump Pump Other: <br /> Water Suppression System No.of Heads ,p/ <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEM : have reviewed this application and confirm the information con fined herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,sta ,an 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 ing 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 wi . CW and 296.200A WAC. <br /> 7/ Caity(off Everett Official Use 1 Ognly <br /> /6,-/ NIZS , * <br /> ...- O <br /> Owner! ut - n Signature Date (Revised 4/15/2019) ,I <br /> Z <br />