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• • <br /> a PERMIT APPLICATION <br /> LI <br /> BUILDING 1 MECHANICAL I PLUMBING/ SIGN/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 Blac(Ink Only Please) PROJECT SITE'.INFORMATION . <br /> PROJECT SITE ADDRESS:/q4 /9., Thi 67-11 /,- r PROPERTY TAX#:60 yeyg4,-2v7—Q l 7`ca <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT:INFORMATION <br /> OWNER NAME: �/f- / 4r✓6 15'' TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET/ '/ <br /> � /2, rA j7,—,,cJ(,�� r�T <br /> /; C11Y cft STATE ZIP 9,-a / <br /> OWNER PHONE Z is> G.....�`/.? OWNER EMAIL:M ak.,IS1C /j1-1/1/1:3 1. I r✓-O/i?. <br /> CONTRACTOR NAME: '(_0W A)E) <br /> CONTRACTOR ADDRESS: STREET <br /> CITY - STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: z ,2---� ...?9 <br /> Mr c/ac/j. 6 //1/ CONTACT EMAIL:� - ‘j:457S oz,z,- - <br /> -=BUIIDING'>INFORMATION <br /> Existing Use of Building: f,�/'/2 Contract Price of Work:$ <br /> Proposed Use of Building: Sf p .. Heat Source: ❑Gas ,, Electric ❑Other <br /> BUILDING USE: iISFR ❑Townhouse ['Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: CI New DAddition ❑Remodel , Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:per'p/i':re �1( -5 rkia-N-0415c <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .. MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION ;..c <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures count ' List of Fixtures Count yLisf of Fixtures Count List of Fixtures <br /> NC—Air Handling Units 0- Gas Piping Backflow reventer(Inside Bldg) / Shower,Tub,or Combo <br /> Boller / Gas Range / Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> l Clothes Dryer Heat Pump&Ductiess / 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 Flreplacellnsert/Log Roof Drains Water Heater <br /> SPRINKLERISUPPR.ESSIONSYSTEM • • •• Sewage Elector orSunip Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads. <br /> • <br /> ACKNOWLEDGEMENT:!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,stale,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In writing from to <br /> Building Official before being authorized under any circumstance.i am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 10.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT it <br /> M. UJtoo'? -6Gz <br /> Owner Authoriz'd Agent Signature Dat (Revised 4/1512019) <br /> i ifid !(v"r <br />