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PERMIT APPLICATIC . <br /> BUILDIIaU I MECHANICAL/ PLUMBING /SIG PRINKLER/ DEMOLITION <br /> 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 2 <br /> PROJECT SITE ADDRESS: /O S- PaC,'f(L 4ve4c/L. PROPERTY TAX#: 00437s-72301101 <br /> 72301101 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1- (/ie „ of Klt 11 , TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING Ad6RESS: STREET /al q fact' fc ,-vee U� <br /> CITY g-,r? 7 STATE WA- ZIP q520/ <br /> OWNER PHONE: 1-2Z6-7 ()cf,SOWNER EMAIL: <br /> CONTRACTOR NAME: I 5 P <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):1R 1CGC,C C 216 UITY OF EVERETT BUSINESS LICENSE#(REQUIRE : ?)CCIA t <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR PrOTHER(Please Specify) !``C11,7-ey'-' <br /> CONTACT NAME: A/ CONTACT PHONE: 126'--2-SV-Mee <br /> V" CONTACT EMAIL: /yll"1 es .,bnhctrcji,60144 <br /> BUILDING INFORMATION <br /> Existing Use of Building: gj Contract Price of Work:$ /0/az) <br /> Proposed Use of Building: g Heat Source: ,($Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: —EtCommercial DAccessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ,®`f.l. ❑Sign ESprinkler ❑Demolition ❑Change of Use <br /> DE*RIPTION OF WORK: Ada ✓t% Yl cud /Yf'- <br /> - I.11'0"..,5c c, 0. do&r �o ,,v„ ,f, c. �'�,�1.) <br /> C) 1C� • �,J <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 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 lam 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 /> 15)2017 "B(C103-610 <br /> 0, er/Authorized Agent Signature Dat (Revised 10/10/2018) /�, <br />