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PERMIT APPLICAT10111 12 BUILDIN,MECHANICAL / PLUMBING / SIGN , SPRINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) r t PROJECT SITE INFORMATION PROJECT SITE ADDRESS: ,'g 12_ \ (o ;:•\rI Pc.). PROPERTY TAX#: O 0'439 t-TA b02,000 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) \ / CONTACT INFORMATION I OWNER NAME: 7 p ng ut,..\ 1�w 0.4,3 TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET k.5 S z_'3 ?dikCz.c -"VC CITY 5U r fl ,A STATE $ C • i ZIP v 9(1.5 J C.o T 7 'T7 OWNER PHONE: g'r--S$5-s s 55 8 OWNER EMAIL: fp \�S�W�h a \ rc'-1Y�0.� 1. n CONTRACTOR NAME: �,euNoS . 5ons .J -ZS Qf CONTRACTOR ADDRESS: STREET s'7.20 \iik S. S: )CITY �a w,d A45 STATE W46,- ZIP sgo CONTRACTOR PHONE: 010 6 —Ok`y- (p St-A CONTRACTOR EMAIL: '\-- Ail C '"5 vY\-__ CONTRACTOR LICENSE#(REQUIRED): N,e\J jQ.5.‘0 g t2," F (CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR OTHER(Please Spec—y) .cYx-Gt y A CONTACT NAME: `^/t ved <J `� CONTACT PHONE: LA-Z5 —-75 Lk_ $9 6 D 1 ►` CONTACT EMAIL: q\(KQ p QyD r-,e0,\A 7 0 ti os ,CQvyk BUILDING INFORMATION Existing Use of Building: t'), un'0,- �af-A-v`,ne.„ Contract Price of Work: $ 5 OD, Qe- Proposed Use of Building: �p___ \Ai.Q.“\\"1a\ Heat Source: ❑Gas SElectric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU L!Multi-Family-#Units: VT... ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel VRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Se -!.e A'\tor \0\5AS CAA' \v\COcc c*\y ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION I Fixture I 1 Fixture I Fixture ' List of Fixtures �"tore List of Fixtures List of Fixtures List of'Fixtures Count Count Count Count 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. City of Everett Official Use Only # \10 ` 2. k PER OZ�outc Owner/Authorized Agent Signature Date (Revised 10/10/2018) 1.