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4reffrr PERMIT APPLICATION <br /> BUILDIN'-1ECHANICAL / PLUMBING / SIGFsai i RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIGL:: <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink OnlyPlease) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4(76 TA 1610 k1/`kPROPERTY TAX#: 0057 H-7 00 2-C0 (O `J <br /> LEGAL for new construction: Short Plat/subdivision _ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ���7��1 <br /> OWNER NAME:Cr/(/)f �(��,k--Cf TAA,S�' TENANT BUSINESS NAME(Commercial): 7f' outs-jail --riu Y L/ <br /> OWNER MAILING ADDRESS: STREET1,000 l J f 8rn St , l � I <br /> CITY 6(I Lif IAA....- STATE WA' ZIP q 3-6YJt <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: RtAtef S j4in 0. 1 Q'/( t/ <br /> CONTRACTOR ADDRESS: STREET 240$ `i-vv." l till 5 <br /> (O <br /> CITY ','j+tii— V-WA STATE Wa2,73v a2,73CONTRACTOR PHONE: 3(,(J 142,1113)-S 111 CONTRACTOR EMAIL: 5+---1--A4I e e v,{,cc l et ily. Lam_ <br /> CONTRACTOR LICENSE#(REQUIRED):MFAv.,v_5 L56 Ci-3. < CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 573 I D <br /> PRIMARY CONTACT: ❑OWNER .CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: s?-)Lej .L.A2 u— 13 2 s- <br /> 1�- (�1�lt• � (' UL\ CONTACT EMAIL: 5-k--'�'��(\li'.Il�IM..�.(,�19fc)i q11. 1 l;0A_ <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ `000 • C) 0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: -commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Insf ,.i k <br /> CM tIA1 01\e rltw P0A- \ �I AsiCL\"e- S w MA- 5;Gt(\ <br /> 176(\Ct. si‘k ?(A1\41 ()'1 t IC‘ .k--"\-1 Tf.e-C-Stav\citrN‘l . --14in, <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 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/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 the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ti City of Everett Official Use Only <br /> ",,- ` .161PERMIT# <br /> �o2 <br /> I <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />