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Il PERMIT APPLICATIOIS 112 BUILDINAECHANICAL / PLUMBING / SIGN IlirPRINKLER/ 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: 7(7 R r ii I PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: )�.�k I Yr tJtr�VL k I to j F-1 y TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 2-( 12_ S P ;,vt-t' ')-I CITY ` Li -tk STATE Lo ZIP `f( I OWNER PHONE: 't1 t-`� 13 --Ai. 2-- OWNER EMAIL: CONTRACTOR NAME: A./,A- CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: A tv` I ( 0 i 1 , cowl CONTACT EMAIL: "� BUILDING INFORMATION Existing Use of Building: Contract Price of Work: $ Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other BUILDING USE: ILSFR ❑Townhouse ❑Duplex OADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: j?j& (TWA). r- ..D t A4lvei b . rvl:4.2- 4kt. 1 {6k« (" W Iv 5 Lveiq . I.e vvkoi%t-4'O ek11 mu— 5-i^vc-1v rc It u-et tt S oat AdAtt Secs _R o o lam, 'VFW M I"6 : '. y.i T 7 i/ I N Dt O lewa Y b• sec iel 4 'or 6 :1 -I- ,-16OR a t cl s K-y w i hda,:. .vEf. (iL t MAi,iq— "N5TA-6-1- 0,7C 41-( 0pi1c s �' yt 1� E >. �/�. 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 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 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 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT## mob 0 1 Owner/Authorized Agent Signature Date (Revised 4/15/2019) 4 /Z--