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PERMIT APPLICATIO <br /> In <br /> BUILDINGOECHANICAL/ 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 /> g <br /> PROJECT SITE ADDRESS: SS O/ SOV"id e1v e .veve illte/4 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: icts 2ce /i'(tl6 ,L2f' 1TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET V17/ ?S /�en 6 S''I h S-t S()f (L 20 /}�/�(' <br /> u pCITY .47/]1, 00 u ,/ STATE Gv/1' ^/ / ZIP Y[>O Z <br /> OWNER PHONE:,.,211 <br /> 2S— 9 (J 36?-?V "` OWNER EMAIL: bra(, Walt,-0Lt Q�tier(' C ©C 144 <br /> CONTRACTOR NAME: 1+l l a-O 69//�1/Vel ii✓1 fQ/la(1 2GC <br /> CONTRACTOR ADDRESS: STREET !T7? f'O any. ly AI 6'2O•� <br /> CITY _ryehet/ Clitg STATE l(.(,14- ZIP / b'Y�L'1l/ <br /> • <br /> CONTRACTOR PHONE: YzS,S-�/./�^OScS"& CONTRACTOR EMAIL: cF'p1OCOMJ•/7'(/C 1(o4 , !l/JjjrjTj'i'�Cliti icri� <br /> CONTRACTOR LICENSE#(REQUIRED) /y hL Pie rr 33- ;/ CITY OF EVERETT BUSINESS LICENSE#(REQ/UI_RED) V r/ <br /> .,,.' :.., .. -.,.., <br /> PRIMARY CONTACT: 0 OWNER CS CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:D CONTACT PHONE: ', ?J-;iTS-0 SS s / <br /> uit!(LC l j� So J� CONTACT EMAIL: �`/ IOCYxgr��VU C�I U✓(A 't/ t P GeG•'{/! (04.ei <br /> � y rq <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ /2/ OI2L2 <br /> Proposed Use of Building: Heat Source: ItGas DElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: OCommercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ?Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> f)(0f446/<i fYv 47Sf' .-ReG2/ode/ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): V / '7 O "! - 01 <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) 3 Shower,Tub,or Combo <br /> Boiler Gas Range / Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless 7 Dishwasher 6 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain I Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 3 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/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:/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 /> 41111" PERMIT# <br /> Owner/Authori •d Agent Signature Date (Revised 4/15/2019) <br />