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ism PERMIT APPLICATIOS <br /> ni <br /> BUILDINGMECHANICAL I PLUMBING I SIGN 1 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: ?5'1 r ta'nfecr `- f PROPERTY TAX#: 1,?'0 SdGo t c?GC <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t-a +-t ,�LTENAANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET ?Svc 1-1 01 rcf -p- c C� , <br /> CITY rrt,,e.f(- STATE (,' a— ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (,✓c.S 614,,, (?GI / DCBL Ste*I <br /> CONTRACTOR ADDRESS: STREETW! _'I 83,? q/Sf CZ�t- we' <br /> /' <br /> CITY 4C q tom; a STATE z, ZIP 9-P2J 1> <br /> CONTRACTOR PHONE: II d•5- 75 'I titer) CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER IZCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 sir -7, ( L/(t'I 2— <br /> CONTACT EMAIL: CL,-Sies.t{)t.);�✓t 4'k'' g ai(erS7 , 6.).(' 1 <br /> BUILDING INFORMATION <br /> Existing Use of Building: O F'IZ Contract Price of Work:$ ` <br /> Proposed Use of Building: rc7 F g- Heat Source: ❑Gas Electric] ❑Other triK Gli r <br /> BUILDING USE:itfSFR 0Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition ®Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: / •\ - <br /> Ki vj l L� G(,C,rL�l l � 6�5�" ''Z I' YQG U+^ ��i'/y0 <br /> 7Fir -r--l' i3(g1 Z,UO? <br /> e� f <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ' eip(m J h't[rst n�l1Grrs 4 t P"- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> Count <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) l Shower,Tub;or Combo <br /> Boiler Gas Range a Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> ,( Clothes Dryer Heat Pump&Ductless Dishwasher 'r I Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain .•-.- Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain J.. 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 /> 7 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 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 /> PERMIT# <br /> Owner/AuthorizedAgentSignature SI nature # Date (Revised 4/15/2019) <br />