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PERMIT APPLICATIO <br /> BUILDIN ECHANICAL / PLUMBING /SIGN RINKLER/ DEMOLI ION <br /> E V E R E TT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 UlA <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue fa ti 3@k Ink Only Please) PROJECT SITE INFORMATION <br /> PROJEC. vi_ ADDRESS:2 L1 y2,1 Z[S P[se L.vc $)J CUM PROPERTY TAX#:O%9 t I©on°4I D 0 <br /> LLGN_for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION _ _ _ " - <br /> G'vv`+dE t. TENANT BUSINESS NAME(Commercial): <br /> • <br /> 'OWNER MA:LING ADDRESS: STREET 1 1 3/0 'Z. 1' A f E S E <br /> CITYY7 EVxxeti- STATE t 0 A ZIP p�,©Q <br /> li <br /> OWNER PHONE: L O k2rJ x iO OWNER EMAIL: <br /> I COi TRAti'C?NAME:: B Q 4 ke 1 iI-1 E /c - -' <br /> - <br /> rIICON dRAC T OR ADDRESS: STREET <br /> j CITY STATE ZIP <br /> i <br /> [CONTRACTOR PHONE: 1CONTRACTOR EMAIL: <br /> l <br /> !ICOMIkACYO€ LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 'OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> I'CONTACT NAME: CONTACT PHONE` 3 6 0 7 ?.3 2 q© �-- <br /> F <br /> IcoNrAcr EMAIL: - c, <br /> .rj <br /> BUILDING INFORMATION <br /> I!Ex!sting Use of Building: Contract Price of Work:$ I-1(9©0 . a''O <br /> i.Proposed Use of Buildinj Heat Source: ❑Gas ❑Electric ❑Other ' <br /> [BUILDING USE OSFR (ownhOUSe _luplex r,DU ulti-Famil -#Units: :ommercial ccessory Structure <br /> Type OT Project.1 e: w j Nodition remodel ,.epair 1 .I. ign brinkler ;emolition hange of Use <br /> +LE Ck P'":ION.Oic WORK: <br /> . ,.r <br /> WOv, V• art C osuk-i roiw \/ room emt ziy,i1'room cluw e L b eti <br /> ASSO ,A SUi D u G PERMIT#(if applicable): <br /> iI ._ _I_, EC ;:.L PMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count =1st of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> ij lA/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> 7Bo,,er Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> 0. <br /> o Clothes Dryer a Heat Pump&Ductless ti Dishwasher Sink-Residential(kitchen,bath,bar) <br /> jj .Sys m(Remodel) i, (Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> { Exhaust Fans(Residential) 'Commercial Ventilation) Floor Drain Toilet <br /> `Exhaust Hood(Type I) !(Not Heat/AC system) ! 1Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater 1 (interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential)!( !Wood Stove i! !interceptor-Sand/Oil Water Service(behind meter) , <br /> fl� Forced Air Systems `Other: !Medical Gas Water Valves or Fixtures <br /> t <br /> a Fsep a en sertr-og 'Roof Drains Water Heater <br /> SPR: s,€EE! UPPRESSION SYSTEM (Sewage Ejector or Sump Pump Other: " <br /> i'Wat r Suppression System No.of Heads <br /> !,Chemical Suppression System No.of Heads <br /> ACKNCWZEDGEi!,-ivT:I have reviewed:his application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current:odes, state. and;coal 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 Offi,iai 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 corup'; ii:ea State Corr a a_a,v 18.27 RCW and 2966.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# 1(10 —02-9 <br /> Owner!"'� Je:Agent Signature Date (Revised 10/10/2018) <br />