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MIN PERMIT APPLICATION <br /> BUILDINGOECHANICAL / PLUMBING /SIGN I 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 /> PROJECT SITE ADDRESS: 27 I i.1e-r)Ao 17. G PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f j40Li EhENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> 4 CONTRACTOR NAME: % 1-1/4 kiSoi <br /> CONTRACTOR ADDRESS: STREET ''7i 1 14 C rf iJ km/6 ju I.azf✓G <br /> CITY t EiZe-rr STATE IJA ZIP 9E32 ;3 <br /> CONTRACTOR PHONE: INrj— 'z '3095 CONTRACTOR EMAIL: 41.HAii< 1J f0-0 LAD, (•) <br /> CONTRACTOR LICENSE#(REQUIRED) 1-I .G1 151 DS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) �. 05 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR %OTHER(Please Specify) fileH,TFcL--r <br /> CONTACT NAME: AL, " WI L 02- CONTACT PHONE: ‘) ._'I I -ci34-6 <br /> CONTACT EMAIL: •1"p.'1la e_pEs il,,,)4I2L"stt p .i,,/'ki&& r( -1 <br /> BUILDING INFORMATION <br /> Cr-)Existing Use of Building: 1345, Contract Price of Work:$ t <br /> Proposed Use of Building: bus. Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Apt) +�c of fie __ `'- C of 'J c-r Ce5 1,.Ic•k-lam'N1 -JU 7--e-5(z-Uor,- <br /> 11 I <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ov f <br /> ECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fi ure Fixture <br /> Count List of Fixtures count List o tures Coun List of Fixtures Count List of Fixtures <br /> A/C- it Handling Units as Piping Back reventer(Inside Bldg) Show , ub,or Combo <br /> Boiler Gas Range Clothes Washe ' k-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remo Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans sidential) Commercial Ventilatior Floor Drain -\ Toilet <br /> Exhaust d(Type I) Not Heat/AC system) Hose Bibb ri <br /> Exh t Hood(Type II) W r Heater Interceptor-G se WasteNVarerfaipj.Qg Repair <br /> aust Hood(Residential) Wood ve Intercep -Sand/Oil Water Service(behiii meter) <br /> Forced Air Systems 7 <br /> Gas Fireplace/Insert/LogOther: Medi I Gas Water Valves or Fixtures <br /> Roo Drains Water Heater <br /> SPRINKLER I 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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and/comply wi the State Cent tors Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> j <br /> PERMIT# <br /> i/ Iig12 - D \2 <br /> Owner/A ri d Agen Ignature Date (Revised 4/15/2019) t <br />