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PERMIT APPLICATIO <br /> BUILDING /MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> °te CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 6yfq Eve,�/QRp by PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): MomDS .L 1e- <br /> OWNER MAILING ADDRESS: STREET 'e�{zzuRarr <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: f7 }/// PKO PLUMBIAIO .YNc - <br /> CONTRACTOR ADDRESS: STREET , 7 EeNfR41._ y4V2 S • <br /> CITY <br /> L keht f STATE //A ZIP 932 <br /> CONTRACTOR PHONE: (206)166 -b10,5 CONTRACTOR EMAIL: d r <br /> f prvpi m1ft- n f,C ��„ .yy� <br /> , '_ C� <br /> CONTRACTOR LICENSE#(REQUIRED): , y9/AlPP8 q-9P7' CITY OF EVERETT BUSINESS LICENSE#(REQ�UU '• D). �R q <br /> PRIMARY CONTACT: 0 OWNER Fi CONTRACTOR 0 OTHER(Please Specify) A,' "!: ,ti- '`It <br /> CONTACT NAME: CONTACT PHONE: `�— <br /> �6 - �6�-oio5 <br /> aQh' CONTACT EMAIL: 'al / O <br /> 111 .Lir i441_ Lt ' . #1.1 r <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 14 oOO <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ,IC• . •'..L. •Accessory Structure <br /> Type Project: P g p Iti ffi Jelt f- <br /> T e of ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Sin ❑S rinkler ❑D ; oli I�� 6'� <br /> A f� �' <br /> DESCRIPTION OF WORK: R 1� �c x`,- "I �^ _J_ `` L .., I <br /> p � -� Cbl91Q� (,GA t.FJGt-� JAN <br /> 4 20,9 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): CITY OF j�'�+E R, .r_. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT4 adAT c <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 Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer 0Z Sink-Commercial(3-com ,prefloor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain f Sink-Utility,laundrymop <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 l 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:- P,>.vt/-(AJaJ, Atizt. <br /> Water Suppression System No.of Heads ft rmiti <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 /> ns o q/2/0 6 t <br /> ( — W 3 <br /> Owner/Authoi4zed A,gent Signature ate (Revised 10/10/2018) <br /> / <br />