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= PERMIT APPLICATIO• BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION 32 EVERETT CITY OF EVERETT PERMIT SERVICES 00 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: /0 I5 ?) Y S'T PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: L-rIr f'H (A h �fl(U TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET IQ f j ?la,L- S1 1 CITY ueLI STATE - ZIP ��32U OWNER PHONE: 1--AZ� v)(1",( C (P OWNER EMAIL �L 1 h 10 ve) �'''l�. I C om CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: J OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Li as_ S")(� ._(,�(,) o ' -*k: tC(A11(Ot� CONTACT EMAIL: EC._ G1�1)0 V C� C) �1'lCi I I I C(UYy7 BUILDING INFORMATION Existing Use of Building: . -�--1 Contract Price of Work:$ (01JO0• .r Proposed Use of Building: j t� Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE:igSFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: El Commercial Accessory Structure Type of Project: El New ❑Addition DRemodel El Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use DESCRIPTION OF WORK: "• 'c1� a n oo 6.e GjV 1k c,(X'ki p� t o3,-(A \lr ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures count List of Fix es Count List of Fixtures Count List of Fi es NC—Air Handling Units Gas Pi ' g Backflow Preventer(Inside Bldg) Shower,Tu r Combo Boiler Range Clothes Washer Sink- mercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher ' -Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residenti- Commercial Ventilation Floor Drain Toilet Exhaust Hood(Typ- (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood pe II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust •.d(Residential) Wood Stove Interceptor-Sand/ ' Water Service(behind meter) Forc-• •it Systems Other: Medical Gas Water Valves or Fixtures .s Fireplace/Insert/Log Roof Dr ' s Water Heater PRINKLER/SUPPRESSION SYSTEM age Ejector or Sump Pump Other: W- -r 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. City of Everett Official Use Only PERMITt C Iv O ne Authorized Agent Signature Date (Revised 4/15/2019) 1/ /Z--