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I <br /> PERMIT APPLICATION <br /> BUILDING CHANICAL/ PLUMBING /SIGN /S KLER/ DEMOLITION <br /> E V ER E T T 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: ,, '') ` J 5 i 52. L1L n \WA `i$APROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �h'� i:?\1,4-Kt J</ L'/ TENANT BUSINESS NAME(Commercial): <br /> OWNER <br /> �7 MAILING ADDRESS: STREET ) f 7 (_O y AV / <br /> Y?J 77 CITY 1 A STATEW /%�I.�J, ZIP I U U I <br /> OWNER PHONE: YYY OWNER EMAIL: <br /> CONTRACTOR NAME: VaLL Q5L VJJ J AM ve I/vI;J\ff) L4 )K <br /> CONTRACTOR ADDRESS: STREET fly J 7 (()Lev A `- <br /> i;-, ) ) CITY V Y' l STATE 5 r3/ ZIP <br /> CONTRACTOR PHONE: (tea. 1.5E -- /-,3 CONTRACTOR EMAIL: w/A,CONTRACTOR LICENSE#(REQUIRED): N/4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): AV <br /> A- <br /> 'CONTACT: $OWNER 0 CONTRACTOR 0 OTHER(Please Specify) C l <br /> CONTACT NAME: N , / i/ t y CONTACT CONTACT PHONE:��5) l0 — 71 � C <br /> ri�� �1 ky4 711) , i NV �1 co,,, , <br /> BUILDING INFORMATION <br /> Existing Use of Building: A)",y l NO NIL Contract Price of Work:$ �,) <br /> Proposed Use of Building: 1, 1f/r\WO Heat Source: OGas kf,-lectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU )Ylulti-Family-#Units: 1l_ ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ,emolition ❑Change of Use <br /> DESCRIPTION OF WORK: '��h011t_ U N PLZ1vd I '.�;i,(. <br /> V T C-1. 1�-1J • uxVV/ t :1���jr A-D v 1-I�C/) V <br /> AEov� .�k tZt414-`/ Ohl bla.] <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 Backnow 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 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 /> ��___ PERMIT# <br /> 7//6/�.o,)_ Bui Za07'6`1S <br /> ) orizedAnature Date// (Revised 10/10/2018) <br /> 1 <br /> /Z <br />