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PERMIT APPLICATION izi BUILDING / M HANICAL/ PLUMBING / SIGN / SPk KLER I 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 I, 10 1'I/\Q, S4'. / tb8ke. ("ik 671g20 PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: C41 p� - liate,41L TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREETS -60 Cam/ S-1-, 1, CITY Ey4--e ESTATE /i ZIP 9 u/2-0 ( OWNER PHONE: HZ,S -ZS7'3��0 OWNER EMAIL: M�OJFelso� getrBre- �a • O‘ I/ CONTRACTOR NAME: )'r'n--411 S4VU VkO'1 1 CONTRACTOR ADDRESS: STREET 1 O,,I( tS4- k\u-e._ SO� ^�� , Zi 400 CITY `)�ry l STATE WA- ZIP c s Gil CONTRACTOR PHONE: 2 0 6 —ln2 1 d2. C, CONTRACTOR EMAIL: e_/o S l/ 0 °_4rn....0.CC.Go, CONTRACTOR LICENSE#(REQUIRED): .FO prCC / g®p CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):SIN PRIMARY CONTACT: ❑OWNER XCONTRACTOR 0 OTHER(Please Specify) CONTACTCONTACT NAME: ((�� CONTACT PHONE: 2,0 6 -�KG - U I \2 I- o G A\ ciCL. CONTACT EMAIL: mpr^Qn S cg c�,,,.,G (L. Co,. - BUILDING INFORMATION morn Existing Use of Building: O4 pc,eJ Contract Price of Work: $ I I3,7&6. Oo Proposed Use of Building: O('f.y Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ORemodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: cull roc,} 46,, p- t; ,.-¢96ct -..l- a-\— 41-t cAy o0 Fvz-¢4-1-- utter Ca-, M fr- 2. EI ec-,'c4 ati& e a..:cal Qe►-kwo w;l R (zE v.. ..'- ASSOCIATE 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 Ventilation 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 with the State Contractors Law 18.27 RCW and 296.200A WAC. aCiitty�of Everett Official Use Only 14.701/ 7/3i f 2�r5 PERj \lJ� 03Owner/ uthgnature Date (Revised,�44/115/2019) (1.21)