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miiii PERMIT APPLICATICHI <br /> BUILDINO MECHANICAL I PLUMBING / SIG PRINKLER I 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: 26 2 I (7/Fit ND A U PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: DA/V/E4_, -it' /k / /S77 /-60J/Lf g TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 2&2 / 7''A/VL A124- <br /> CITY v5A / ( STATE 1'A cr A ZIP 9 / <br /> / <br /> OWNER PHONE: OWNER EMAIL: £ Cc 4!C(. r lilac a4t4z✓. Q P,pa4CaS A•e f <br /> / />. <br /> CONTRACTOR NAME: /`1�.� /)7�i"y E77f0(I7 Ci Z'}. %inA C if 2 / <br /> CONTRACTOR ADDRESS: STREET 343 /-/647 5i< X2) <br /> CITY {/,6Q ?/,( STATE /2/� ZIP .q(fLC/, <br /> CONTRACTOR PHONE: 4'Z --SZ9',3 - 79/L. CONTRACTOR EMAIL:/Yi// 2f4'4-11 GI.eZK¢tA66.1`/', Grp <br /> CONTRACTOR LICENSE#(REQUIRED): 7//Q/VH 93/P.3 CITY OF EVERETT BUSINESS LICENSE#(REQUI ED):,4//22. <br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR 6THER(Please Specify) /'A74(1/ Z�/114 / p s07/1/ � <br /> CONTACT NAME: //A Aril <br /> Z./14 CONTACT PHONE: (206)8�'b -9 Z3 <br /> h CONTACT EMAIL: yz Cc-c./ 66414 <br /> BUILDING INFORMATION <br /> Existing Use of Building: S/pil(b(.- FA'/ - G� //5_,A(C4.- Contract Price of Wory: O0O <br /> Proposed Use of Building: , F i Heat Source: C Gas ❑Electric 0 ther <br /> BUILDING USE: I26R ❑Townhouse Re❑//Duplex ❑ADU ❑Multi-Family-#Units: ❑Commerci ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition I.� model El Repair DTI. ❑Sign ❑Sprii,,n/kle ❑Demo'' n ❑Change of Use <br /> DESCRIPTION OF WORK: /_ /- Cx(s-T t,�l7 F/N(s/- /�il�tit,(6l'U r- f ,FP//(/7, 1 (Q Z3 r 1.q <br /> ASSOCIATED BUILDING PERMIT#(if applicable):( C5 t' ikIossk�\P o k: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION _ � � / <br /> Fixture Fixture Fixture Fixture - r 6 <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count t o F xtu es <br /> A/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Comb9---- <br /> Boiler Gas Range Clothes Washer Sink-Commergiaf(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-R.sidential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigerajion- Drinking Fountain .Sirrk-Utility,laundry,mop <br /> Exhaust Fans(Residential) Coercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) j <br /> Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residents Wood Stove Interceptor-Sand/Oil,,f'°''" Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/In Log Roo(Drai W Water Heater <br /> SPRINKL /SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression stem 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 /> City of Everett Official Use Only <br /> 3/ PERMI`( .Cl ,� OI� <br /> bate (Revised 4/15/2019) <br /> Owner/Authorized Agent Signature )/ <br />