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PERMIT APPLICATI LTI BUILDINtik MECHANICAL/ PLUMBING /SIG SPRINKLER/ 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: L'3 l7 5 04' rS .W PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: J yD V�•-f-c' TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET (:"'S\ (.A. S CITY ejArte 'e STATE yV2:, ZIP 9s-203 OWNER PHONE: `{Z 3 1,( -1 3 5 OWNER EMAIL: CONTRACTOR NAME: ,S A-14f l PI r�wI,ID� I 1-G -�•-uJ U_C CONTRACTOR ADDRESS: STREET Cl(Z terti 4 CITY VIAL0{/L< STATE //t/iy, ZIP ' '2. 2.) / CONTRACTOR PHONE: �Zt - °lof—Q`iC.> CONTRACTOR EMAIL: Se; -le. C t- FL„,l,�}a.11 - `Cvr '✓k,<<:Ctktl CONTRACTOR LICENSE#(REQUIRED): S&A T-FCC e211 m UI CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ( U � PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: tpwvi--1(1 t,./� CONTACT PHONE: Y 2 9 c s- a t f CONTACT EMAIL: BUILDING INFORMATION Existing Use of Building: tee r ,�r Contract Price of Work:$ 3 5 Q Proposed Use of Building: Heat Source: Was ❑Electric ❑Other BUILDING USE: MSFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: c)10110-inlj '10 Or MAW) ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION ''t 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 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 with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PE MI (yv.)2_ c.),(0 wner/Authorized Agent Signature Date (Revised 4/15/2019)