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PERMIT APPLICAT <br /> BUILDINAECHANICAL I PLUMBING MI <br /> / IGN RINKLER/ DEMOLITION <br /> 32 EVERETT CITY OF EVERETT FERMI E <br /> 00 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: O� �f' c�/,� ,,� i i JA ' IF /U� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: [-I /�, i( u� i L. it /, Al TENANT BUSINESS NAME(Commercial): /VI i ju+ 14CAI th t Spi <br /> OWNER MAILING ADDRESS: STREET 96,(/ coveit/wee,V ik/`%4 sit:1NO2- �f <br /> 3 CITY (�i€lc t� y STATE W/ • I ZIP /z9pp© <br /> OWNER PHONE: �1›5- S wj"-�s0 17 1 0 _OWNER EMAIL: C.r�(-E l i(r 4 ca,D I Clecid: C c a1 [ 777 <br /> CONTRACTOR NAME: S 54 C�-S <br /> CONTRACTOR ADDRESS: STREET`/ /91 O K F L-J 24. 'ZT A <br /> CITY [ ' hVI ,�Li STATE 3 - ZIP7&617 <br /> CONTRACTOR PHONE: 2c �y ._tug ) C LIP <br /> EMAIL: ' F=... , , j 6 < (try <br /> CONTRACTOR LICENSE#(REQUIRED): S12c ..7 L 9�- CITY OF EVERETIT BUSINESS LICENSE#(REQUIRED): ")W2- i <br /> PRIMARY CONTACT: 21 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: j O 5_ 3 5 3 —(�7/ 0 <br /> Ani h i.k i C h e N CONTACT EMAIL: 6 a 1-4 (ei i-{5.)..0(L, I,,LA C c,t1 <br /> BUILDING INFORMATION <br /> Existing Use of Building: ('r7M i4 r C I A I-. Contract Price of Work: $ l... ; <br /> Proposed Use of Building: Heat Source: OGas '®Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: DZCommercial ❑Accessory Structure <br /> Type of Project: LJNew ❑Addition ❑Remodel ❑Repair ❑T.I. *ign ❑Sprinkler ❑Demolition ❑Change of Use _ <br /> DESCRIPTION OF WORK: <br /> T7,J �cam-G <br /> „,.. <br /> ,O1 cz�- „ } Cam - �1��-1'1 <br /> II r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): t 2 k )c?( �. <br /> / <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) _ 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 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. <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I <br /> 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> X <J i bj C ,P/n I VS /a <br /> Owner/Authorized Agent Signature f Date (Revised 10/10/2018) <br /> I <br />