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PERMIT APPLICATIO. al BUILDING ECHANICAL/ PLUMBING/ SIGN /SPRINKLER/ DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 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: 641D6 J`1�74 ?d 'Q' D.Q PROPERTY TAX#: .&-S.3/?ODSezy� LEGAL for new construction: Short Plat/subdivision Lot No. ,i (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 7CY'47,L1--41 '2 4 dv`t_'A5/A TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 6 YPG /`t% X2 -41" 29,' CITY l�=e7e<e-!/:-/ STATE leJ ZIP /ct 3 OWNER PHONE: y 2J 2 9 3_-yr 9 OWNER EMAIL: Pie©i"7eE'4'<L4�2'1 4. ,r.ee0-77i'e',e,ev07 CONTRACTOR NAME: rW/7e-� CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: V(OWNER 0 CONTRACTOR 0 OTHER(Please Specify) _ CONTACTNAME: 739-7 .494/4- CONTACT PHONE: 2O6 2 7 7327 }/, 4'Y/e Y,6 CONTACT EMAIL: YS,, GYq'y y4 ( 72;?..i oa. cpsy) BUILDING INFORMATION Existing Use of Building: ,-C,L— Contract Price of Work:$ '7$, OeD Proposed Use of Building: ,oe'- YiedQieAloe 4,;I4tPU,Heat Source: ❑Gas RrElectric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex MADU ❑Multi-Family-#Units: ❑Commercial Accessory Structure Type of Project: XNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ,6 �/ Z -y �/ �0 r 'c �� / ,, ,q.04/ ' -C ot/ rill e R a'-e, 26/- $i P 01 "3-chi W,', ', : Zo/ /r1-"C'..3f - ?'r,. ,S 1 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 Gas Pippg Backflow Preventer(Inside Bldg) / Shower,Tub,or Combo Boiler ` GastVtge / Clothes Washer Sink-Commercial(3-comp,prep,floor) / Clothes Dryer ,V :1 at Pump&Ductless I Dishwasher 2 Sink-Residential(kitchen,bath,bar) Duct System(Re.,53o l) ti/ 'I Refrigeration Drinking Fountain Sink-Utility,laundry,mop r3 Exhaust FaIQs)(b�Yesidentla) Commercial Ventilatior Floor Drain f Toilet Exhaust Hood(Type l 1 (Not Heat/AC system) Hose Bibb ( (/V Urinal Exhaust Hood(Ty I Water Heater Interceptor-Gr / Waste/Water Piping Repair Exhaust Ho esidential) Wood Stove Interceptor-Sand IA / Water Service(behind meter) Force if�Systems Other: Medical Gas Water Valves or Fixtures Gas F�place/Insert/Log Roof Drains ,-, Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewagefjector 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. ----- -- City of Everett Official Use Only 2 PERM - _ , )0 \C I 0 -00-4 Owner/Authorized Agent Signature Date (Revised 10/10/2018) Vz.,