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NM a <br /> 11 LI PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)426 2S7 8810 I FAX 425-257 8857 1(E)everetteps§everettwa gov J www everetiwa govJpermils <br /> (Blue or Black;Ink OnlyPlease) ``, PROJECT Sf7`L rINFORMATINON <br /> PROJECT SITE ADDRESS: { �o te, . flit l 1PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision __ Lot No <br /> (attachoft description) <br /> copy tong legal d scr{pt on) <br /> CONTACT INFORMATION . . <br /> OWNER NAME: A TENANT BUSINESS NAME(Commercial): `T" tAel <br /> OWNER MAILING ADDRESS: uTRsr r i <br /> CITYt l STATE AM , z N b f <br /> OWNER PHONE: 'OWNER EMAIL: <br /> CONTRACTOR NAME. 2ro+V co I p[Yt+t Y4t C ^+ zem,r iN <br /> CONTRACTOR ADDRESS: STREET <br /> CITY . <br /> STATE ZIP <br /> CONTRACTOR PHONE: (CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED) ei (yr p„,.c cierry of EVERETT BUSINESS LICENSE#REQUIRED <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT N{AME::'� CONTACT PHONE: 1avi <br /> Z'' )'22 C ,c� <br /> f u° " CONTACT EMAIL: 4/IAA Ce,® If.D�6,ce l uYy ( ,C <br /> .. . EUILOING:INF'ORiiMMMAT(ON , . . <br /> Existing Use of Building: ,O �tr� Contract Price of Work:$0eq,- <br /> Proposed Use of Building: C4 ■c_: ■ ■e , <br /> BUILDING USE: OSFR DTownhouse DO Iex OAOU C7Multl-Famfty-#Units: � C°Commercial °Accesssory Structure <br /> Type of Project: ❑New t Addition ❑Remodel ❑Repair CIT.,. COSlgn °Sprinkler pi tr) , ODemolitlon A DChange of Use <br /> DESCRIPTION OF WORK: <br /> f 1 <br /> yi tuAID-Vrtel (0y" ci n is 4 D, cmwo,..,5,4,c,r" <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHA.NICAL•.PERMIT.APPeAcATfON;; ...,, . ..... PLUMBIN i.PER.MIT.APPLICATION <br /> Fixture List of Fixtures Fixture Countcount ' List of Fixtures NOW," List of Fixtures List of Fixtures <br /> Courts count <br /> A/C—Air Handitng Units Gas Piping [ BackfiowPreventer(inside Bldg) Shower,Tub,or Combo <br /> .Boller Gas Range Clothes Washer sink•Cammercial(3-comp,prep,ffoer) - <br /> Clothes Dryer Heat Purnp&Ductless t Dishwasher <br /> Duct System(Remodel) Refrigeration DrinkingFountain Sink-Residential laundry,m(kItchan,baiti,bar), <br /> 1 •Sinn-illlflty, map <br /> Exhaust Fans(Residential) Commercial Ventiiat i Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Sibb Urinal <br /> Exhaust Hood(Type 19 Water Healer Interceptor-GreaseWaste/Water Piping Repair <br /> � <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 /> • <br /> <SPRINKLER'I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System I No.of Heads <br /> Chemical Suppression System ;No.of Heads. <br /> ACKNOWLEDGEMENT.l have reviewed this application and confirm the Information contained herein Is true and correct.Work clone pursuant to this permit must comply with <br /> current federal,slate,and local law, The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In milling from the <br /> Building Official before being authorized under any circumstance.lam the owner,or tam authorized by the owner of this properly to patiomt the war*forwhlch application is made, <br /> end 1 campiywith the State Contractors ew 18.27 ROW and 296.2000 WAG; <br /> City of Everett Official Use Only <br /> )(4'1._.,,,,Qe7f .u _ . 3 1 /fJ 0' PERMIT 2,6 —00,a) <br /> Owner/Authorized <br /> / <br /> A n�8lgnature Date: (Revised 44512019) <br />