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(gerr. PERMIT APPLICATIOIb <br /> BUILDING I MECHANICAL/ PLUMBING /SIGN 1 SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <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 Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: sj 1 I) [..f‘,5t S 6 eve]-J- (,✓A 5 '2Qt., PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A-sfe t r3e1A y TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 7/ (C 62 <br /> 1 4111,1E e—CJOff1— LAriA- �I2�©/L{.- ��9j (� �\(� <br /> CITY e v�.j- /y J- STATE A- ZIP l d 2-0 7 <br /> OWNER PHONE: 2 6— 3 54-- cf e J S OWNER EMAIL: 4 S- -C/(x)c S C n ,-,.„. . C nAl <br /> CONTRACTOR NAME: / I A-fl—o tJ R (o, I <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: j(} -35 --O%c CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ,'OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z06--;c t,G- Li(7gs <br /> sF4�' iAy CONTACT EMAIL: A Stt)D e®�41 1, (o'y-, <br /> BUILDING INFORMATION G <br /> Existing Use of Building: b.P s'v1 o C /:4-Y -� Contract Price of Work: $ $00 <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: El New ❑Addition ZIRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: chow l n O i 4 pipe 'u N.,) <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 ( rf 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 r/ 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 /> City of Everett Official Use Only <br /> iPERMIT# <br /> k_iiuir71- 2,3, 2X)f9 'Qgof- ao3 <br /> Owner/Authorized Agent Sign 4 re Date (Revised 10/10/2018) <br /> 1 <br /> I2 <br />