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ii PERMIT APPLICATIOk 12 BUILDING i MECHANICAL I PLUMBING / SIGN I SPRINKLER I DEMOLITION E V E R E T TCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: :),(' , /SLAC/,y/z AV L)PT: % PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 6L15/1/ /`'a!L.Lj_. TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET ,C> . IS DX' /oIC.,C.) 4�7J/Fez 4"-1-� CITY STATE 1....)--/ ZIP q g-,201 OWNER PHONE:Gc% 'Al ,,,,00 /-)4A& /''1 t[[t' OWNER EMAIL: GC4—/ON(LJL AJ 44.),12---d") ICZ CT/�'TA/C, •(c;/�z CONTRACTOR NAME: a ) CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: WWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACTNAME: CONTACT PHONE: L/25;7.77. c,/7? y�S- 4'.i 9, - .23 9 i)- 6L -/'"/ Afi LC/'/1- di A(`) /S'/r(L/ L CONTACT EMAIL: 6 C///J/A) Lc/......-,—") 4)/:-..i4 X51 G-/ST/ i L - L No BUILDING INFORMATION ^ -` - Existing Use of Building: JY/ L\L '7 ' /1 z Contract Price of Work.$ r)c / Proposed Use of Building: Heat Source: ` Gas ric. ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ,Multi-Family-#Units: 7 ❑Commercial ❑Accessory Structure Type of Project: ONew ❑Addition si Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: A/0O iveer /c-:" ' 120016"i /.-'o60 /p=-- et-/ 4N4 PQ. ° co 0/3T /e.i9"fl CQ/c .-..,-'U /�A/k) ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust Hoo'd(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Il Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads. 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 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 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, and l comply with the State Contractors Law 18.27 ROW and 296.200A WAC. mCity off Everett Official Use Only ::::: ....._ 0G2 9___ Owner/Authorized Agent Signature Date (Revised 4/15/2019)