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• • <br /> MI <br /> PERMIT APPLI- . I <br /> 112 <br /> BUILDING /MECHANICAL/PLUMBIN e I SIGN/ -PRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PER SER - S <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: 2c?5P C U(.by f' kit". t vc gC(( 'IJ('1ii PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of tong legal description) <br /> � ` //CONTACT INFORMATION <br /> OWNER NAME: GL l>Cf) s►til G (�Ws G TENANT BUSINESS NAME(Commercial): G(10E-/) Si1.{O ' O(,,, <br /> OWNER MAILING ADDRESS: STREET 2 C 3g- co1,b y i\--,t- t v ,�i " A Ci lc20 i <br /> CITY STATE ZIP <br /> OWNER PHONE: ,f l4 , G O OWNER EMAIL: kc k Ir-e_e 'V) T C ")1i c1 t L CC1-, <br /> CONTRACTOR NAME: i\A ( _''e,rS IQ'Ei2IJ S 1GAJ <br /> CONTRACTOR ADDRESS: STREET '2-2 i 6 C C)U S‘ , cg. <br /> CITY . --‘,t'Cg: ( STATE 1 ZIP qt2C/(S <br /> CONTRACTOR PHONE: 4 ZS 7 TO. C) . - CONTRACTOR1 EMAIL: e_v e..Y C-c( C� 0,0\ CI'� <br /> CONTRACTOR LICENSE#(REQUIRED): IA i s 1S O�`�(—/ CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) __. <br /> CONTACT NAME: CONTACT PHONE: (Jv 6 , 611. 4-("jC. , ` <br /> � �� L \ CONTACT EMAIL: � �'r�`���` 1 Cc U \ CL7m <br /> BUILDING INFORMATION <br /> I <br /> Existing Use of Building: d7 r Contract Price of Work:$3:1 ( U <br /> Proposed Use of Building: 34c,6,4 .5 ' Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑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: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): '1/Vj 0 R1- G. L iT S t4A) . � Uk <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) 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 I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I 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 /> ��. <br /> D U� �21 PERMIT# S Z u <br /> Own /Authorized Agent Signature Date (Revised 10/10/2018) <br /> k <br />