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1 PERMIT APPLICATIONS <br /> noel BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov I vwuw.everettwa.gov/permits <br /> LQ Or SIMON - Plano) PROJECT SITE INFORMATION <br /> PRWECT SITE ADDRESS: Li-7 f 6 Si 11,E a 4,fe . F./,..•-4t til,d, PROPERTY TAX#: <br /> GAL far new aor on: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNERNAME A i/( Gf/t pl c$'41--d tt TENANT BUSINESS NAME(Commercial): <br /> OWNER MAIUNG ADDRESS: STREET ef ('F' e CRC"-Q.t/`-- <br /> CITY E Nly/urL -'f STATE (, zP Z,1'23 <br /> OWNER PHONE:L(' -'42..6—5 7'3 OOWNER EMAIL: <br /> CONTRACTOR NAME: y Ut/V <br /> CONTRACTOR ADDRESS: STREET <br /> CRY STATE 2P <br /> CONTRACTOR PHONE: (CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): <br /> PRIMARY CONTACT: INOWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ) CONTACT PHONE: �ZS= TZ 6— 773 <br /> r 3Il y (4/145777 h CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use at ' Contract Price of Work:$ \f)C) <br /> Proposed Use of Buikbng: Heat Source: OGas DElectric QOther <br /> BUILDING USE: 011SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> <�"�s�// p''1t L 5 4yt a/( ,Bci�ii r.-f3 r"-r �zr vt L.,,h,,,,,,,,,:y <br /> ASSOCIATED BUEDIIG PERMIT#(if applicable): <br /> MECHANICAL PEIr MIIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ixterer List of Fixtures F <br /> List of Fixtures CbottNun List of Fixtures F�n List of Fixtures <br /> Count CountNC—Air Handing 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(kitchenbath,har) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> t' Extenst Fans(Residential) Commercial Ventilatior 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 Suppre n System , No.of Heads <br /> ACKNOWL IIF I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit roust uxmrsmgr with <br /> current federal Melo,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in swiiing horn the <br /> Sulking Official berme being authorized under any circumstance.tam the owner,or lam authorized by the owner of this property to perform the work for which applicators is made, <br /> and I comply whir file Slate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> t/ _ Z PERMIT# n,' �-105 — 09 5 <br /> Owner o l`�Owner zed Agent Signature Date (Revised 10/1 J/20` 1t 8) <br />