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N° <br /> PERMIT APPLiCATIO <br /> ILI <br /> UILDING I MECHANICAL I PLUMING/SIGN I SPRINKLER/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: kv 1 ' fcve # 22.5 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial):ei arc,.I S D <br /> OWNER MAILING ADDRESS: STREET e <br /> �l 0 144 I cit tS6 22s <br /> CITY0 j STATE ZIP s ZD 8 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: E- '/ z ,A ,.9-7�;-,:_ /I r /._ <br /> CONTRACTOR ADDRESS: STREET Z/ZO PA-CAC, <br /> CITY kk.. O.L.Lt STATE [A-Mr 1 ZIP Vk` 1 <br /> CONTRACTOR PHONE: fiz>> 'z.5Z-3/I`I- CONTRACTOR EMAIL: Char_i SS-e.a S )4 c £o'Yfr l <br /> CONTRACTOR LICENSE#(REQUIRED): �U FM 5C72ZC0T— CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):O0`7 of SS <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,509 "'413L4 4 tOg <br /> C a.r 1 Sce...a eAs CONTACT EMAIL: ejirlax-:\ l SSm wa' C-Um <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$_ I Le 1 7 <br /> Proposed Use of Building: Heat Source: '®Gas ❑Electric ❑Other <br /> BUILDING USE: CISFR ❑Townhouse ODuplex DADU ❑Multi-Family-#Units: $ ommercial DAccessory Structure <br /> Type of Project: DNew DAddfditiioon� DRemodel pair DT.I. DSign n❑Sprinkler ❑DemolpitionJ ❑Chang/eNoff Use <br /> 1 �/� <br /> DESCRIPTION Or WORK: '"t " "C f, 10 -r� K._.T(A• UJ I I N) In OM I oaten.. • <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 /> I NC—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/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System INo.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.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> an c ply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ktic <br /> (01,City ofEverett Official�UseOnly <br /> /V V t L� — /1J/10 (/ PERMIT PL' :!/ J00" <br /> en/ uthorized Agent Sign re Date (Revised 10/10/2018), <br /> Yz <br />