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PERMIT APPLICATIO• <br /> BUILDIN MECHANICAL/ PLUMBING I SIGN /SPRINKLER / 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 www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 6 5/4522 'At/ G<c!�///f� .0� SE� PROPERTY TAX#: cv©.S g/74,OS'42© 'cap <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �G'©/ ///P//t/fj' �' .e/G�j TENANT BUSINESS NAME(Commercial): 7; <br /> OWNER MAILING ADDRESS: STREET 63 'c ' 7�G J ©mil" G'' 't //-3 <br /> t-,�e/e e T CITY STATE 1�✓ /7ems_ ZIP 9g n 3 <br /> OWNER PHONE: '/Z S 3 Y3— y©.5 3 OWNER EMAIL: /<"" G4( // vE.co"") <br /> CONTRACTOR NAME: ©w""9e <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR BOTHER(Please Specify) "9/2C-4-1/4-V-v-/v y.9`1�.0y/Z. ' <br /> CONTACT NAME: Z4-sLOr- l/-i" 9YRC yi4 CONTACT PHONE: Zo6 <br /> CONTACT EMAIL: y5.4 4c /y 2 yCC4 ygAoo.carr/ <br /> BUILDING INFORMATION <br /> Existing Use of Building: > Contract Price of Work:$ 'Z 5- O, oo C <br /> Proposed Use of Building: $L� Heat Source: kilGas ❑Ele lc DOther <br /> BUILDING USE: ESFR ^Townhouse EiDuplex EADU '!Multi-Family-#Units: ECommercial _Accessory Structure <br /> Type of Project: Kiew ❑Addition L iRemodel ❑Repair CT.I. ^Sign LiSprinkler Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: "'X/S y7..7 ,lovS Ai'r7G-S4_ <br /> 6'4i/Lt 25io.2r "7'0 h-,'T/- .}7r,9 CoHI�'iii�.i.sG <br /> /ze.9- 3 0/7 ref .5—/. ©.c. .4-45 ` ' 1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1„-AA) \LCe-f12-1 <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) c/ Shower,Tub,or Combo <br /> Boiler / Gas Range 2 Clothes Washer — Sink-Commercial(3-comp,prep,floor) <br /> '2. Clothes Dryer , Heat Pump&Ductless / Dishwasher '7 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) ' Refrigeration -- Drinking Fountain / Sink-Utility,laundry,mop <br /> c�"- Exhaust Fans(Residential) Commercial Ventilatior .,.-. Floor Drain T- Toilet <br /> r Exhaust Hood(Type I) (Not Heat/AC system) 2 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 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 Jaw. 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 /> C� City of Everett Official Use Only <br /> 0,q/ 0 ( /) 0 0 PER) D J V2 V <br /> Owner/Auth d Agent Signature Date (Revised 10/10/2018) <br /> - —1 <br />