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= PERMIT APPLICATIO <br /> BUILDINGiIIECHANICAL/ 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) n PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ?A 06 (V 1 k k- S4 • - -N.k\e--"±( PROPERTY TAX#: L T072a96 ij0O�©O _ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copyof long legal description) <br /> ) <br /> CONTACT INFORMATION <br /> OWNER NAME: Ud 4 ''TO - 1,3 5 A, TENANT BUSINESS NAME(Commercial): <br /> !� --E-Vi 'I j <br /> OWNER MAILING ADDRESS: STREET [V 2 O11 7...4 I Je, S W <br /> CITY - f{ \-e STATE 1!lt ZIP c'g ILL c <br /> OWNER PHONE: 70 C.—() 3 (7-63 g`t5' OWNER EMAIL: We v A J 1- a'« ho'+M4' ( er'i-i <br /> CONTRACTOR NAME: l . V!r SC 15 (Vie S 1.4 -" <br /> CONTRACTOR ADDRESS: STREET et D ov. 7._E-A ( ) <br /> CITY -1 �` l STATE W'� ZIP J O`J 3 <br /> CONTRACTOR PHONE: '(2 J—.HS--�3 .6' CONTRACTOR EMAIL: 1 ?-e.e e1 i Nit a v l J , ,f) iv' <br /> P l- <br /> CONTRACTOR LICENSE#(REQUIRED): (41?-- 31-i L 3 , r) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 7 <br /> PRIMARY CONTACT: ❑OWNER Cr—CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: . 1 { CONTACT PHONE: j t.6-�L� -1 3,4j <br /> A(C I kC CDM 1 1►m CONTACT EMAIL: I y..,cx-•?6-1.:( f Q, cl nite? I (, '-'iV <br /> � ` BUILDING INFORMATION <br /> Existing Use of Building: /%4 Contract Price of Work:$ OTI 000 i <br /> Proposed Use of Building: -Z,t ev_ .!,4'i (,) Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: El Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: CO A <br /> -OA JC ,A,.0 1 <br /> CC{\41 61,ka ( hi- 74.60 <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 ki Gas Piping Backflow Preventer(Inside Bldg) [ Shower,Tub,or Combo <br /> Boiler Gas Range l Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> jClothes Dryer Heat Pump&Ductless ( Dishwasher 3 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain 1, 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 1 Water Heater <br /> SPRINKLER/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 /> c '1 City of Everett Official Use Only <br /> e <br /> PERMIT# <br /> 'el/ i/ 212g/20 73 W ;00 3 '*- 6°i4 <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) <br /> 17 <br />