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® PERMIT APPLICATI <br /> BUILDI MECHANICAL/ PLUMBING /SIG PRINKLER/ 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: A/f J Y &1 ..Pl!2 W�l 7 G PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision t1Yt )/F ¢oi o.? (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 174_c SL C k TENANT BUSINESS\ NAME(Commercial): <br /> Lf =� Y C <br /> OWNER MAILING ADDRESS: STREET %i! �e�9 Y �� Ut n` G`� <br /> CITY T ( C✓� l f STATE Ui /- ZIP Q `-C <br /> ) y <br /> OWNER PHONE: Z 3 6 7 Cri 0 9 ('C) OWNER EMAIL: <br /> CONTRACTOR NAME: 7,57(R ( onA '` i( [-IBC n <br /> CONTRACTOR ADDRESS: STREET f ``� " c L S -, r e L Zo <br /> CITY E.tip'/(? f4 STATE Al f1 - ZIP 9 > L( <br /> CONTRACTOR PHONE: 3CC� `( 7 —9,f l-- CONTRACTOR EMAIL: I-n y AEI )-: I'3 '3 C 11 1.A/li i''. <br /> CONTRACTOR LICENSE#(REQUIRED): �K�� (;,o c I 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIR ): <br /> PRIMARY CONTACT: OWNER 2 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: "� , 0 ,_ Gf :1 `L—L/ j II <br /> Tip Cy rt ve CONTACTEMAIL: iJi►'11"t r+-L� I I I S v l.c.�i 1 •(Vy <br /> BUILDING'INFORMATION <br /> Existing Use of Building: ! ,.s v._(�"9 Contract Price of Work:$ ;2-(J(; <br /> Proposed Use of Building: Q Cij< try Heat Source: OGas JElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: ❑New $Addition ❑Remodel El Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 /> 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 I 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 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 omply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 40, (C/ Za/ (q PERMI r ,b c <br /> ( `` <br /> 0 n /Authorized Agent Signature Date (Revised 4/15/2019) , / <br />