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• <br /> OM PERMIT APPLICATION 411 <br /> LI <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WAS H I N GTO N (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:/' -x 5-1 41. `z<,/ e2i/ ,/' Y t'4'-% PROPERTY TAX#:N°{#O)`i/6C 000 00 7OO <br /> LEGAL for new construction: Short Plat/subdivision ZQ,2 OO 8t1 71 of 0.2.Lot No. 6 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Pa/Avg vg r✓ 1 64/v~,,r✓. TENANT BUSINESS NAME(Commercial): ,J74 <br /> OWNER MAILING ADDRESS: STREET _Fj ij i7 L( \.,J <br /> CITY4;ini?:f yj' STATE /ft/40 — ZIP Y2c ? <br /> OWNER PHONE: ,25.g, 6 fr:O. OWNER EMAIL: Xi 4/1. ' & 44/i, 4:Cu'1 <br /> '7 <br /> CONTRACTOR NAME: /. , / ( <br /> i <br /> CONTRACTOR ADDRESS: STREET .:W (�"/////'' ,�� <br /> CITY 4C-/4 � STATE Zfn ZIP 7.6:2ZV <br /> CONTRACTOR PHONE: 9-: sy" Ptni.j23 CONTRACTOR EMAIL: 701149 f Ji(?, 67m ../j 4 l` �d�'� <br /> CONTRACTOR LICENSE#((REQUIRED):( p7:!'/l4/iy ,78:3 .,� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 09/7 ' <br /> PRIMARY CONTACT: A OWNER ,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 r 1/67 'Zi.)✓ <br /> 774.. J '/7 iti,4Aii .CONTACT EMAIL: --"Fe ,L?viL4.,./dp �,t'd,I.4-/if l z sf' i <br /> BUILDING INFORMATION / <br /> Existing Use of Building: /0- Contract Price of Work:$ A 3, C'C' t <br /> Proposed Use of Building: ,5;/ Heat Source: AGas DElectric ❑Other <br /> BUILDING USE: SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project New ❑Addition ❑Remodel ❑Re air ❑T.I. ElSign ❑S rinkler ❑Demolition ❑Chan a of Use <br /> YP J � PP 9 <br /> DESCRIPTION F WORK: <br /> /VA) copAff` re-i7,,A, ir4 loArorti 4/909'✓t .427 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): I/Ofi Ai"(0— 12 01 . P L b <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION _ <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures count List of Fixtures C nt List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) 3 Shower,Tub,or Combo <br /> Boiler / Gas Range ( Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> / thes Dryer t Heat Pu Ductless / Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct em(Remodel) Ref' eration Drinking Fountain l Sink-Utility,laundry,mop <br /> j Exhaust Fans esidential) ommercial Ventilatior Floor Drain y Toilet <br /> Exhaust Hood(Type (Not Heat/AC system) _Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater -interceptor-Sand/Oil <br /> Waste/Water Piping Repair <br /> / Exhaust Hood(Resi ial) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Sys s O Medical Gas Water Valves or Fixtures <br /> / Gas Fire a/Insert/Log Roof Drains eate <br /> SPR)NI(LER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System INo.of Heads <br /> Chemical Suppression System I INo.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.!am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the S to l�ontractors aw 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> , PERMIT <br /> „Zi <br /> Owner/Authorized Agent Signature Date (Revised 10 : . : <br /> i e 441 02--0616a - Z(bZoLk'l, <br />