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PERMIT APPLICATION , <br /> BUILDING:/MECHANICAL F PLUMBING!SIGN/SPRINKLE /DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32to!CEDAR STREET,EVERETT,WA 98201' <br /> (P)425-257-851 Q 1 FAX 425457-8857 ((E)everettepstbeveret#vaa +f wyvw.everettwa govipermits> <br /> e or Black Ink-Only-;Please) ' a PROJECT SITTE'I$P*RMATION , <br /> PROJECT SITE At3E3RESS'. '78-1714-h '>. „�. <br /> r. - tt,te 1124 :PROPERTYTAX#1: 0 t .- <br /> LEGAL for new construction: Short.Plat/subdivision Lot No, (attach copy of long legal description) <br /> .S' <br /> ONTAV'T I FORMATION <br /> OWNER NAME: . ,, . `rp' ? .' T BUSINESS NAME(C dal) <br /> - OWNER MAILING ADDRESS: STREET <br /> CITY STATE... ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: LI Md bi <br /> CONTRACTOR ADDRESS: STREET fi ti .: I 1.1,o44 % / <br /> CITY 41 t • sTATE . 2IP 47 <br /> CONTRACTOR PHONE; 4.1' tONTRACTOR.EMAIL: Ptd tit <br /> CONTRACTOR LICENSE#(REGIUIRED): P 3 RS CITY OF EVERETT BUSINESS,LICENSE#{REt UIRED):cts—qssii Ej <br /> PRIMARY CONTACT( Q OW NER ; CONTRACTOR CI OTHER(Please S aecif) <br /> CONTACT NAME: ""/CONTACT PHONE: 4 a,.. -I `v. . <br /> 14 CONTACT EMAIL: ' �.'i- ) �' <br /> B1JILDING.INFO,RJi ATION• - <br /> Existing Use of Building: COftract Price of Work:$ <br /> Proposed Use of Build n. Heat Source: Leasill DO Es <br /> BUILDING USE: Irani "'nhouse: Alex E. <br /> iit�I__ 'Fp " Until mmerCial i esso S#rltcture <br /> Type of Project; dition ®model pair .: 111 ririkier ® olitibn ■ang�e of Use <br /> DESCRIPTION OF WORK: a <br /> d <br /> ASSOCIATED.BUILDING PERMIT#(if applicable): I qt)Z b(3 l� <br /> MECHANICAL PERMIT AP*LICATONN PLUMBING PERMIT APPLICATIONI <br /> Frxeure List of Fixtures " List of Fixtures: fixture List •ofFfxtures; � List cif Fixture§ <br /> Count: octant Count COunt <br /> A/C—.Air Handling Units Gas Piping Backflow Preventer(inside Bldg)' Shower,Thb,or Combo <br /> Boiler Gas Range Clothes;Washer Sink-C r ;rcial 3-co <br /> Clothes Dryer pleat Pump&puctiess Dishwater Sink-Residential(kitel en,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,map <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-Il) Water Heater intemeptor-Grease• WastetWater.Piping Repair <br /> Exhaust Hood:(Residential) Wood"Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air SystemsOther: Medical-Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log a Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION>SYSTEM Sewage Ejector.or Sump Pump Other <br /> Water Supprestion`SYstemNo.of Heads <br /> Chernibel,Suppression System 1 Iblo .of Heads <br /> ACKNOWLEDGEMENT:1 have reviowed this appliratiorr'and confirm the information containe0herein is true and correct.-Work done pursuant to this permit must comply with: <br /> current federal,state,and local low The•granting of a-permit;only authorizes approved work and no deviations'fheretrotn Deviations.most first be authorized lrrwriting front the <br /> Building Ofr'ct isl,before being authorized underrany orcxunstance•i; the owner ort am<akthprized by the owner Of tIespropertyto peiforfn the work for which,app/tcation is made <br /> and I comply with the.State Conk- %;Law it;2Y RDWand 29.6,200A WAC; <br /> City ofEveretf Official 1.10 Only <br /> PERMI`C � <br /> 4 <br /> Iq /Q <br /> ,,,,,,,,,,,,/Owner/Authorized Agent Signature Date (t'evised 10/0/2018) <br />