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= PERMIT APPLICATION <br /> LT <br /> BUILDING IECHANICAL / PLUMBING I 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 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /0- ? ,`( } I I V{ / 5 - PROPERTY TAX#: <br />• LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,Liq/(J d Cj 7 rZ Vi�, TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: (STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: i'f 0'J Pry._ry._ p role( 4--%a <br /> CONTRACTOR ADDRESS: STREET "le P-)OW4 4/i,1- Grec (L IDCt\i/t. /9 <br /> CITY G/.e ek6„._ STATE L4 et' ZIP *6 / Z Z <br /> CONTRACTOR PHONE: 1125 ---7p/-r7a—1 CONTRACTOR EMAIL: A r o iJSfk 5rsi q(1, Gd,'_, <br /> CONTRACTOR LICENSE#(REQUIRED): /t F j2i ✓ FP�L17 Pk CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t C)2 3E• <br /> PRIMARY CONTACT: ❑ OWNER (3_CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ti 50/--t 70-1 <br /> )1450 /l,l PO b 7 CONTACT EMAIL: arrvt-VJc1/bcd-1 141-c i 1, (Okv, <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work: $ • j 1 ", , <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition El Remodel El Repair ❑T.I. ❑Sign U1Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: i ASA(( (^e ro it c f I cDA. , 0 l i cqu,,se d c((P q S <br /> 041 `%/a i4• <br /> ASSOCIATED BUILDING PERMIT#(if applicable):)I g0 -O(g <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> List of Fixtures List of Fixtures Count List of Fixtures Count List of Fixtures <br /> Count Count <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 Fouitain 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-Crease 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 /if <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 /> (� /0-/y- 20/ -Wit r , <br /> Owner/ iorized Agent Signature Date (Revised 4/15/2019 <br />