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• PERMIT APPLICATION. <br /> al <br /> BUILDING I MECHANICAL/PLUMBING /SIGN/SPRINKLER I 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'Pleaee) PROJECT:SITE INFORMATION ' <br /> PROJECT SITE ADDRESS: 3 323 O A-Kta / v G PROPERTY TAX#: Oo-121 b10t tt 02D 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> .:.: _1 CONTACT INFORMATION I.:. <br /> OWNER NAME: f� 1✓I—I`-�� - f/P(X)11 6 ENANT BUSINESS NAME(Commercial): <br /> ST <br /> OWNER MAILING ADDRESS: mew. 1)v7 ed b t1 /NE_ NAM <br /> I Q <br /> �J <br /> CITY T ✓ STATE NA ZIP 9 W 1 <br /> OWNER PHONE: OWNER EMAIL: r`oiNs k Ca e.) k* t of-5 <br /> CONTRACTOR NAME: AI...L- 06197 j f t FT OP 45oLj+100as -Sri ohoy)i.4 �A1i1{1 1 <br /> ✓/� . <br /> CONTRACTOR ADDRESS: sTREEr 3 3 QQ� �j tuJ E a�'�` (� 1, r C"f��T�'{(��_Q��j <br /> CITY E::V,�Y 1T STATE I'V A- ZIP I V 1 <br /> CONTRACTOR PHONE: if 2-5— 2Se"441100 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ..S'aIQ HOC R 9 4052. CITY OF EVERETT BUSINESS LICENSE tf(REQUIRED)W <br /> PRIMARY CONTACT: %OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: &r.ps O'IJC- jI CONTACT PHONE: /zS 2.5-8 - 1 ydo <br /> JJ CONTACT EMAIL: <br /> ;; BU.ILDINGNFORMATION .", <br /> Existing Use of Building: I?(YR_r n'1 it) r ' Y <br /> Proposed Use of Building: s 9'rm G 0' <br /> BUILDING USE: DSFR DTownhouse ❑Duplex DADU 1/Multi-Family-#Units: 12- ❑Commercial DAccessory Structure <br /> Type of Project: DNew DAddition DRemodel ❑Repair OT.I. OSign DSptinkierr 'O�Demolltion OChange of Use <br /> DESCRIPTION OF WORK: D-�—� u f x s`w 1ST)' G F <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 10 %1 5 r <br /> ;MECHANICAL PERMIT APPLICATION'. PLUMBING.PERMIT APPLICATION: <br /> Fixture List of Fixtures 'r7 Ust of Fixtures Fixture List of Fixtures Fixture Ust of Fixtures <br /> Count Cant Count Count <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 Ventilatiork 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/011 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-HeadsChemical.Suppression ystem 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,end 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 /> c .......Z......./... ---.... <br /> 31 <br /> 8/24 <br /> • PERMIT I, ,�`1 3�021) <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) � j <br /> !Z. <br />