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® • PERMIT APPLICATIONS MI BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER/ DEMOLITION R E T T CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 iUASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION �'/ w'J PROJECT SITE ADDRESS: 6tZ � 5 PROPERTY TAX#: C7PO4/9pa002306 LEGAL.for new construction: Short Platlsubdivision--_ 5 13111i Lot No. 4 (attach copy of long legal description) . CONTACT INFORMATION OWNER NAME: -1- Yam.._. TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET �1z Ri E Lt CITY A. , STATE ZIP 9 p_72_.9 Li OWNER PHONE: �f j2. - 4 Zito e, OWNER EMAIL: f-4'iE(Ze.J. , Mot_E-2 e lq L41.44 L.,CO T.1 CONTRACTOR NAME: 4 V k.A] (:Ly ?_A _ INI. . CONTRACTOR ADDRESS: STREET t 7j411 ....---)11,0Un✓tt.1 J I[CITY Y STATE � 1" 1 ZIP sZ CON C;2ACTOR PHONE: - ( -O(c‘L ACONTRACTOR EMAIL:I i vrr l co r4(moo 0,p, (y CONTRACTOR LICENSE#(REQUIRED): f1/411k5QUAQ Q-jq e...1L CITY OF EVERETT BUSINESS LICENSE#(REQUI : 'D - PRIMt RY CONTACT: ❑OWNER 0 CONTRACTOR AfiTHER(Please Specify) "7vS I (. 1..L--fe...... i CONTACT NAME: CONTACT PHONE: 42..5 -4-22 - LE-7 S�j '1 1 . CONTACT EMAIL: j C-uatk Y14..L� Q L •V1OAST—,04 -j _..,j BUILDING INFORMATION •Existing Use of Building: St=P . Contract Price of Work:$ �• t\loE r k Proposed Use of Building: '4.-- Heat Source: ❑Gas ❑E tric ❑Other i BUILDING USE: ❑SFR Townhouse ElDuplex ❑ADU [..IMulti-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition L1Remodel ❑Repair LJT.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ,. I ' _. �77PC1t-L. I/ g( L(_' '��-I0W�1,L� �- f ASSC GATED BUILDING PERMIT#(if applicable): —_� MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture List of Fixtures Fixture Count 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 Ga Range Clothes Washer Sink-Commercial(3-comp,prep,fk,Ar,-- Clothes Dryer eat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,ba:_ _ Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop _ Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust Hood(Type I) / (Not Heat/AC system) Hose Bibb Urinal _— Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Resides I) Wood Stove Interceptor-San it Water Service(behind meter) ___ Forced Air Systems Other: — Medical Ga Water Valves or Fixtures Gas Fireplace/Inse Log Roof Dr s Water Heater R. SPRINKLER UPPRESSION SYSTEM S age Ejector or Sump Pump Other: V'.'atter Suppression Syste No.of Heads "" Chemical Suppression System No.of Heads — 1CKN;OWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with .� irren' 'ederal,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 B rildn;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.'• :(. u'id!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 4 — �k vwnenAuthorized gent Signature ate (Revised 10/10/2018)