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l I • PERMIT APPLICATIOG• <br /> ui UILDING I MECH A NICAL I PLUMING I SIGN I SPRINKLER I DEMOLDTION <br /> 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 /> 1(Blue or Black loft Only Please) IP ®a ECCit 55TE INFORMATI J H <br /> PROJECT SITE ADDRESS: LI i x ! ri • 1J 1)<v&— PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT IN FOR" IC \i <br /> OWNER NAME: J ry i s3 ;d(� TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET7 - - NE- <br /> CITY CITY { �.� STATE �,./' lV.^a — "" ) <br /> - Z P / ram' 11 <br /> OWNER PHONE: COS—7(i/j'gyqs OWNER EMAIL: "vie l/ — <br /> CONTRACTOR NAME: ( I'";., r%v _ �1 — _ <br /> CONTRACTOR ADDRESS: STREET v(7l � to(1 1 <br /> - CITY '"�"' i a- ' STATE Lid `N ZIP 9 °'' I <br /> CONTRACTOR PHONIC it;5 7((tt 067 CONTRACTOR EMAIL: K�1 kiji,—cQ. ,L_LQ- L'v;,r,•1= <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUI ' vr. <br /> L,— 9r • g <br /> PRIMARY CONTACT: ❑ OWNER ACONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: S= cct — ®c-i'g <br /> p <br /> A 0 C La,),(2. °� 4 g CONTACT EMAIL: 4� le't 9mac= •1,�C.• CA ifY`A0 . c u,, j <br /> BUILDING INFORMATION <br /> Existing Use of Building: 0f I r`', it ti Contract Price of Work:$ (_A — dr-vc <br /> Proposed Use of Building: - �t It ,c v --o'!"— Heat Source: OGas ,BfElectric ❑Other <br /> v <br /> BUILDING USE: ESFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition Remodel ,Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: k ° <br /> irA <br /> G ACT—Et— qf10c" t 0 I� r CIAa (3 I , �� <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 Gas Piping Backflow Preventer(Inside Bldg) NV' Shower,Tub,or Combo <br /> Boiler Gas Range f 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 /> `r. Exhaust Fans(Residential) Commercial Ventilatior\ Floor Drain _ ,)- Toilet <br /> x au d-ffype-I-- (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) d 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 J , - - Roof Drains / Water Heater <br /> SPRINKLER 1 SUPPRESSION SYSTEM r Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System jNo.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 be, .being authorized -r- y circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with •- •tale Contractors . 1: '7 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> C PERMIT# <br /> �- � �0 jw (4 ( 2,— ,f � <br /> Owner/Authoriz•d Agen Sig ature Date (Revised 4/15/2019) iiii on6o �� y�i <br /> e�' i !! <br />