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PERMIT APPLICATIO <br /> BUILDIN ECHANICAL / PLUMBING / SIGN * RINKLER/ 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: J O—! 1 i Mt} /Axe_ 4e. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision •f' T Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br />• OWNER NAME: ,Lc,/,/y Ct Zt'r—TU TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Yl ffri) F�s p;G {c f i -1 <br /> CONTRACTOR ADDRESS: STREET /9.0 /470,14 eez k uf� <br /> CITY ( I Q (�J(,i�y. STATE � ZIP /g-/Z <br /> CONTRACTOR PHONE: Z/7S--3o/- F-y,)—7 CONTRACTOR EMAIL: 'trrv"-1_lJJ/6 a/fi'i eit /, CO b <br /> CONTRACTOR LICENSE#(REQUIRED): Arre,>J FP"y'7 PC CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (.^,02 3(,- <br /> PRIMARY CONTACT: ❑ OWNER LPL)CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Ji4Sa� 6 CONTACTdi PHONE: (/)�--- 3C>l —Ego <br /> CONTACT EMAIL: r4rrdt-sdd/6ed-.9t nu, /, (,0' <br /> BUILDING INFORMATION 'J <br /> Existing Use of Building: Contract Price of Work: $ // cet',s'D <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: LINew ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ,c1Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1154-`l II ?fig i-ect , " _d ' mac,S <br /> Va ( <br /> ASSOCIATED BUILDING PERMIT#(if applicable): J t' 3 C.,t - (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) 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# , <br /> AVI/- eX9 \-10(0 <br /> f � <br /> Owner/Authorized - nt Signature Date (Revised 4/15/2019) <br />