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IIIMM PERMIT APPLICATIO in BUILDINAECHANICAL I PLUMBING I SIGN.RINKLER/ 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: Ji l ` f-)N412 SC,,6,12 1-f C 9() PROPERTY TAX#: �cs Ig(0 aocj`I;� LEGAL for new construction: Short PI division Lot No. (attach copy of long legal description) CONTACT f�INFORMATION ,N F O RM AT I O N OWNER NAME:a-}, y�y�,r�r�a�`��n ,tlS h . F�4fl'ENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET l(D IV(tn 1 AtaJ?_ CITY Sr UL STATE 11 )A ZIP qT l CA' OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: (t:7(.k.t'ik in yt,1/41j14) CONTRACTOR ADDRESS: STREET c`l7 00 )'.4& Ave, s CITY 5C '`i)V./CAMAS It. STATE1.1)74. ZIP CK'CiD CONTRACTOR PHONE: +(- -4C.4.1,c- jj 3L 7 CONTRACTOR EMAIL: lQC( 'iCL&,Q /ant 9 ko • - CONTRACTOR LICENSE#(REQUIRED). K P P ?k CITY OF EVERETT BUSINESS LICENSE#(REQU D) l 5 4 PRIMARY CONTACT: 0 OWNER *CONTRACTOR 0 OTHER(Please Specify) - CONfT�ACCT NAME: J„ CONTACT PHONE: ,(j_a`s/_ ,C{ I - 1 O l�C�tVZ. 0 r 1' drne..- CONTACT EMAIL: �i�fTTXkcie � :n ILLVn W �'1DL It z)ot BUILDING INFORMATION �`�•� Existing Use of Building: ('+,,,' LD-/3( Contract Price of Work: $__ )(5O Proposed Use of Building: Heat Source: 3as ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use DESCRIPTION OF WORK: D .v im (2,)+L 1541 AS 4: (V;1 -A--,,,,, L yeknik efLi\fr ASSOCIATED BUILDING PERMIT#(if applicable): r 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 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 1 Water Heater SPRINKLER/;SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System I INo.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. gCity of Everett Official Use Only ioii P :[ ` Dat _ 1 PET \ l ..... CC(a n r/Authorized Agent Signature 1 Date (Revised 4/15/2019)