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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING/SIGN/SPRINKLER/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 /> (B111e or Slack Ink Only Pl ..) • ; PROJECT SITE INFORMATION -.. . , <br /> PROJECT SITE ADDRESS:1300 B 1 o o' p 1. come_ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT.INFORMATION <br /> OWNER NAME: 7. _ IDN le Bei.- r TENANT BUSINESS NAME(Commerclat):-Tr t (Side Ay%s, <br /> OWNER MAILING ADDRESS: STREET <br /> CITY t STArTEE ZIP <br /> q rj <br /> OWNER PHONE: 425- 212.-2, 08' OWNER EMAIL: d e.- v-(y v(7Ci,1(.ivv.orci <br /> CONTRACTOR NAME: poi Vck 1 I e Mp 1(it.,ra 6 r1.5 <br /> CONTRACTOR ADDRESS: STREET 1 x. 22 CI S 1-3, Owe JOE <br /> cm iNr i, }c ry STATE iP ZIP 9R-22 A <br /> CONTRACTOR PHONE: 3lo o-35 5 -0 4 I i (CONTRACTOR EMAIL:a t(VOL I ley I'3\umk>;hq.F vt tom)a 5114 G t I•C0ra <br /> CONTRACTOR LICENSE#(REQUIRED):AW-VA\(P 832 20 CITY OF EVERETT BUSINESS LiCENSE#(REJQUIRED): 5 R 4 3 g <br /> PRIMARY CONTACT: ❑OWNER ISI CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,73 _2J 5 -C7-1 i 1 <br /> lb . - A CONTACT EMAIL: - . <br /> BUILDING I NFORMATiON <br /> Existing Use of Building: Pcp Crktik AelKIS Contract Price of Work:$.2.4H Li.SSI <br /> Proposed Use of Building: Heat Source: OGas ['Electric (,]Other <br /> BUILDING USE: ❑SFR ['Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel atepair ❑T.I. ❑sign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> row5hiin E' +hm of 1 5(nk <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL'PERMIT-APPLICATION ON PLUMBING PERMIT.ARPLiCAT'ION <br /> Fi' "e List of Fixtures Fixture Fixture Fixture <br /> Count 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 i 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 WasteiWater 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 I SUPPRESSION SYSTEM • Sewage Ejector or Sump Pump Other. <br /> Wateruppression System No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEMENT:/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 1 am authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> �,(.1 , -_ 014/ 01717111— q/Z f PERMIT# p t 610 (4- 0i <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />