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• • <br /> PERMIT APPLICATION <br /> 112 <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/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 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: * 1,(,0 J J ( 4 ) (� �� PROPERTY TAX#: lel <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description). <br /> CONTACT INFORMATION <br /> OWNER NAME: ) A -- TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET (�-( 194-k <br /> CITY E 'e 9/// STATE -" ZIP 18,9 <br /> OWNER PHONE: .;1i6 2'P L„'d31 OWNER EMAIL: P P * L A C31 r, (7,clA <br /> CONTRACTOR NAME: ' 5,Ir.O. <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: ❑OWNER 0 CONTRACTOR OTHER(Please Specify) 1.2F )(�)JP`Z,. <br /> CONTACT NAME: CONTACT PHONE: - '. Awl <br /> CONTACT EMAIL: .F_Acz,tyciA t :�.f 4 Ici(L -G <br /> BUILDING INFORMATION <br /> Existing Use of Building: lj Contract Price of Work:$ 7,3 4,99 <br /> Proposed Use of Building: ' — IHeat Source: Was ❑Electric ❑Other <br /> BUILDING USE: [Silt FR DTownhouse ❑Duplex ❑ADU DMulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New 1VAddition ❑Remodel ERepair ❑T.I. ❑Sign ❑Sprinkler EDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Ape As, a eee')t. t �it - ►-� - - <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/ Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub ombo <br /> Boiler ( ,,.(Q1 Gas Range Clothes Washer Sink-C mercial(3-comp,prep,floor) <br /> Clothes D .9X • Heat Pump&Ductless Dishwasher ,((t Si -Residential(kitchen,bath,bar) <br /> \ Duct System(Nem el) Refrigeration Drinking Fountain g,cCIU' Sink-Utility,laundry,mop <br /> j Exhaust Fans sidential) Commercial Ventilation Floor Drain Toilet <br /> Exhaust Ho (Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust ood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exh t 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/'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 Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> MIT# <br /> W SOD - <br /> PER. D2/4 <br /> • <br /> I L <br />