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imim � PERMIT APPLICATION <br /> Aft <br /> In <br /> BUILDINGl�JIECHANICAL/ PLUMBING /SIGN IIMPRINKLER/ 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 /> � �� ) <br /> PROJECT SITE ADDRESS: 2��` Ink,�,t'�;i F��-✓ Imo' ,}e-`rA -- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Pro <br /> C bf)I PLAI , LI/tet <br /> CONTRACTOR ADDRESS: STREET 1" S`3 2, -1..._\,tt) V 19' <br /> s� CITY L C'1,(.)v[.� STATE (`F"C ZIP 9 1S O c6-1 <br /> CONTRACTOR PHONE: �-�J - 3'2. c C' e- CONTRACTOR EMAIL: A �k-o( l , ow IOov', , e(kr• <br /> �i (� 9 � Cep � � <br /> CONTRACTOR LICENSE#(REQUIRED): ` (�CZ � ; s Q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)SL 3i S <br /> PRIMARY CONTACT: $[OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L)'?_,-- 3 22.— S L i,C, <br /> l — <br /> l C�f\ V--(C' CONTACT EMAIL: �� D,�7� CI I vJ:\` I C�c y., <br /> BUILDING INFORMATION <br /> Existing Use of Building: I (.,L Contract Price of Work i j 0 OD <br /> Proposed Use of Building: (-C i cC. Heat Source: ❑Gas YfElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:AM J ` `,O,NADQAr,NJ (KcL iN00,,,,\ 4 sk,4 j 4 L'-'6( i`--y <br /> ASSOCIATED BUILDING PERMIT#(if applicable): I.)\Ck'I ' - 6 I <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 /> 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 2, Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration V Drinking Fountain — Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation`b Floor Drain _.3 Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) —Hose Bibb _ 2. 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 /> — <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER 1 SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads - <br /> Chemical Suppression System I INo.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.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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 11 <br /> • 2. <br /> } 22-n 1 - c <br /> 11 PERMIT# �y`/'/I6I2� O Qj .� (J <br /> Ow ut orized Agf�t Signature Date (Revised 4/15/201 ) <br /> 4 <br />