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MI PERMIT APPLICATION <br /> MI <br /> BUILDING / MECHANICAL/PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:Z(41U 1/46"s-1-, .rte , WA <br /> t c/ z v I PROPERTY TAX#: o0,1) 760 DZ L OUtti LI <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:f y3,Scc c nor a / Ulu It s u f t TENANT BUSINESS NAME(Commercial):6:G jc-A .( riff <br /> OWNER MAILING ADDRESS: STREET Z LI 10 23“, sk- / /q} / <br /> CITY Clitf c"' STATE I)'1 ZIP L(gtJ ( <br /> OWNER PHONE: /2 S -Zai— Oy q 17 OWNER EMAIL: <br /> p <br /> CONTRACTOR NAME: I'IGtj, LPu F hie,I�il;l,L p';I' <br /> CONTRACTOR ADDRESS: STREET �C,)/ AJ leciuL.1 it A. E1 it/ .. 1 i 3 o 8 <br /> CITY S Q rile_ STATE 1.-4:(_ ZIP 1 II-S <br /> CONTRACTOR PHONE:'/ZS'cit; 7-.5 ,V ZfCONTRACTOREMAIL:P-14r(10 irekp,i:e:; ti;),/ 41(4'74;1/ . CvJr) <br /> CONTRACTOR LICENSE#(REQUIRED)a-lc�i p'V`qt"(1 1 C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Q,$S o t/3 <br /> PRIMARY CONTACT: ❑OWNER ETCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 41 Z S - C 6 7•— Z 7 <br /> ..tn C e., j j�" 1121('U CONTACT EMAIL:'Je.iF2,t1 j F?4.44, Mcc1 u,A;0(1,1 C.. Le ill <br /> BUILDING INFORMATION <br /> Existing Use of Building:6 3 7 /:';_f k.L/y j`_ Contract Price of Work:$7-II ( 7 <br /> ti0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ETownhouse ❑Duplex DADU ❑Multi-Family-#Units: D6ommercial DAccessory Structure <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WOf"" �� <br /> � '�;ni 004s)2.. LfG+ j I i1 <br /> r <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) 7.... 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 SystemNo.of Heads <br /> IChemical Suppression System No.of Heads <br /> ACKNOWLEDGEMENT:1 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!am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply wi the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> — � <br /> � 1-1/e Z `� PERMIT# RI, <br /> I1,0t..k... <br /> O er/Authorized AtfwSlgrtatnFe------__ D (Revised 10/10/2018) <br /> 12- <br />