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PERMIT APPLICAT <br /> MI <br /> BUILD / MECHANICAL/PLUMBING/SIMI 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Q 61 N Q d-pe,dWc.y PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision // Lot No. (attach copy of long legal description) <br /> p CONTACT_INFORMATION <br /> OWNER NAME: R e i•Zhr CO•({-az_ TENANT BUSINESS NAME(Commercial): pep.,„�it o..e <br /> OWNER MAILING ADDRESS: smEET 7; 1 r'P.d Prs..' Gl Ve <br /> cm, cvrVe{r STATE ko ZP q na.-O <br /> OWNER PHONE: , 3- Z�-1 - i-,3 4. I OWNER EMAIL: drec,( -( it,ciw 1 i t . do yh <br /> CONTRACTOR NAME: Q itA/4 (-O,S-(•.-,, -:.Wt) <br /> CONTRACTOR ADDRESS: STREET g6ti o YA k.1 yv n. Ol V / ' <br /> CITY "fp.CD M/ti / STATE VOA— ZIR (1Q 53 4-q I/ <br /> CONTRACTOR PHONE: Z. -�.'t--'' - )- '( CONTRACTOR EMAIL: .j H.aDiAs.f•1^►IGf":of6 WA-I-&illy").( ‘CCw ` <br /> CONTRACTOR UCENSE#(REQUIRED): 46- 3(3 -61t CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6•r6-3/3-'6/`'� <br /> f C <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: /1 CONTACT PHONE: S�3 _a a L - .a-3 <br /> ( ©c1 S'vl0 /1 InN CONTACTEMAIL: SINA. Co1AS,-j-U(. -zQ'V 1AI/}-av,(StWp,zt,r.ON', <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ /OCCO, 322"--- <br /> ` <br /> Proposed Use of Building: Heat Source: OGas �'6,,E.,/llectric Other <br /> BUILDING USE: CISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Z1 ommercial ❑Accessory Structure <br /> Type of Project ONew I�Addition ❑Remodel ❑Repair Ott. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: nq f <br /> /Uew •Tote* o.vtA. UritAie ComitherG,al kif&ttc +or ,,i-zip g0901 o�K4. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Np`S y C `s N • J <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fbriure <br /> n xture <br /> List of Fixtures List of Fixtures CCount List of Fixtures List ou Ott List of Fixtures <br /> CouNC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer / Sink-Commercial(3-comp,prep,f oor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher 2 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) 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) ., 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. Crt ,.SG, <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System i No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and con-ed.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 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 /> (� /� City of <br /> Everett Official Use Only <br /> 1J oc& S()� 4t &) - 10/g/jam PERMIT n l b~ O2(0 <br /> Ow r/Authdzed Agent Sign ( / Date (Revised 10/10/2018)� <br />