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Aimpo, '' II IIIIIIII PERMIT APPLICATION II II II <br /> BUILDINJ4INECHANICAL/PLUMBING/SIGN/&I-WINKLER/DEMOLITION <br /> 1,74 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: 1320 f4ftt'Ln(t) pJ QL r el% I 't7'(PROPERTY TAX#: 0 tJ LI Li 2' b0O0 f 300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No.N(t (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /i( ('it712 (A/I L.-i(7,4 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 31'0 /4/41/149 W DA1% //L t �2,r <br /> cm' �%`t 2'92''( f` STATE vj ZIP l Ql1,0+i <br /> OWNER PHONE: `1 2-c) 1( O — S-1 OWNER EMAIL: elf o(.0 , I.v 11 r-uvl a PA. <br /> CONTRACTOR NAME: itrwn r^,) (7Ji4TJ; rtivt Gina .l 1 <br /> CONTRACTOR ADDRESS: STREET 1-Ce(Z 1,10)(41 0.1- f,q- (_ �J <br /> CITY STATE// LA)4 ZIP a W14;'CONTRACTOR PHONE: c Ce 2 ��( L YGt I CONTRACTOR EMAIL: 1M6tW a-1 ar-t S C @ t (• e. -'l <br /> tn��ErJ CrCB� <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE kultRj <br /> PRIMARY CONTACT: rJ 6WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: iM l> ev147`/S CONTACT PHONE: S.-LetL <br /> CONTACT EMAIL: rutet T f p„/ti,1 s ye_ 0_ J`'+s A t O ver <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ ,pa°o=)-- <br /> Proposed Use of Building: Heat Source: CI Gas ET-Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse I3uplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: CI New DAddition ❑Remodel LrRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 0v , fJO _ <br /> pvr✓1'iN g J'ifin/r7u� <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 /> NC—Air Handling 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(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 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 •-State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 7t(71/ <br /> PERMIT i 0 \ -6 <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />