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imi PERMIT APPLICATION lai BUILDING INECHANICAL/ PLUMBING /SIGN /1111,RINKLER/ DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (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 PROJECT SITE ADDRESS: 3 Z.Z(/ CoL.(3 y Ave-- PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) pp CONTACT INFORMATION OWNER NAME: RO5 L R T Y 1Z0 SVZ r7 TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET .3 ZZq G-UC.ay. A Y6 ,,/ A CITY v,e R\.+ -r T 1 STATE 'WA-,4 ZIP OWNER PHONE: /25.- I,Sc L - 3SG 7 OWNER EMAIL: CONTRACTOR NAME: ,SN.FRASaC.)12_C-C S(; vTZ_'1:S L-C.C_ CONTRACTOR ADDRESS: STREET /y/03 sr?' ,4 IIt ler R.i CITY// ,n fue-//- Q- STATE 6vA ZIP 7 8 Fj `Z CONTRACTOR PHONE: CS 3 6''131 d CONTRACTOR EMAIL: !)Q4.-y//G:k rfottec xt ,Dscr•C/%7 CONTRACTOR LICENSE#(REQUIRED):3T VFi2i4 L $7 t C 9- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OS 1 9 Qg PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) F CONTACT NAME: CONTACT PHONE: el 2 J --s- /c - `�Z a O 62.Q-Ct y AL-Ki°< De (Z CONTACT EMAIL:ae_ / /1-GG ZG, .Io Cl- /�eS'Cc, c O 071 BUILDING INFORMATION y Existing Use of Building: Contract Price of Work:$ / Opa,, GC) Proposed Use of Building: Heat Source: ./EIGas ❑Electric DOther BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: mmercial DAccessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: RC69 C- 4 rso-1/ Of rl �' ne-J-c � 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 NC—Air Handling Units 3 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 Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair 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/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 I comply w' he State Contractors Law .27 RCW and 296.200A WAC. City of Everett Official Use Only / 3-"? P �`� �0 OW cq9 Owner/Autho i ed Agent Signatur Date (Revised 4/15/2019)