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MIMI <br /> . PERMIT APPLICATIOI. <br /> BUILDING / MECHANICAL/ PLUMBING/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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:(;C 1 SE Cl/lac:'-OWE- -- ' l PROPERTY TAX#3,c34 J c c 36 y 60 c <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A/ q(s. 0.,, r,s ..A ;E 5 T/1t C TENANT BUSINESS NAME(Commercial): '7-' 1 , <br /> OWNER MAILING ADDRESS: STREET tV 9 4 7 tCIr1 Cc+.-a,4. �c-i ' �69 <br /> CITY L,tyl L{ ,t-% STATE 41 ZIP 9.3.0 1 <br /> OWNER PHONE 0 - ' -b - 5'42 7 5f OWNER EMAIL: <br /> CONTRACTOR NAME: A L`u¢riv c-.2 a c t caArs. <br /> , <br /> CONTRACTOR ADDRESS: STREET 1 3? may S i /Aft").t44" a <br /> CITY �'%/l, A��r-/ W/STATE ZIP Ci. 'C5 <br /> CONTRACTOR PHONE:,2S�'-I'll- clog CONTRACTOR EMAIL: /VS L.. ( c iv\i (}v4- : L : L :'g`t <br /> CONTRACTOR LICENSE#(REQUIRED):A-D VIc,JSL 11 Is Q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ......c.-?•-CI S..'- 5 CI L CI <br /> r cYJ 4k. ' �{" 1 c \r- CONTACT EMAIL: L , P itAis't ► 4 ) (s v'+."-i L . l' l <br /> BUILDING INFORMATION <br /> Existing Use of Building: `0 vV QC-:.. NA. Contract Price of Work:$ S., 0 C C) <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ETownhouse ❑Duplex ❑ADU EMulti-Family-#Units: $Commercial ❑Accessory Structure <br /> Type of Project: ONew ❑Addition ❑Remodel ERepair ❑T]. ign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> i rs q C - ? L t 0 (-V A`\S gr's +b e't :SiNz IJj C;c , 4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 /> NC-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior 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: <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 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.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 /> City of Everett Official Use Only <br /> '—"---- PE # <br /> O r/Authorized Age trt Signature Date (Revised 10/10/2018) <br /> {�1 � <br />