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PERMIT APPLICATIOI� BUILDING/MECHANICAL/ PLUMBING I SIGN I SPRINKLER/DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 W A S H I N G T O N (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: 6 c' z /7/ '( 4) SC (PROPERTY TAX#: ©053/x'o.c j 3cap LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: / d/Z ///e//l/f9 �C.4 ;:t.'/G'5 TENANT BUSINESS NAME(Commercial): ��- OWNER MAILING ADDRESS: STREET 63Z / '/2'W--�1 12A' U/✓'/r- � e'r CITY STATE 1-4 7/! — i ZIP gZ3 'OWNER PHONE: 'V e S 3 V3- ycP S, OWNER EMAIL: iC42.0 CONTRACTOR NAME: ©Gfi des" CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR (.OTHER(Please Specify) / /e---,,-s'�/iG�iD Y S�`7�yQY/LY�i CONTACT NAME: Z4t-6Go4-' .(/-z"W yk'5/,4 CONTACT PHONE: 206 2 Ve, -93 Z9 CONTACT EMAIL: /S- gq/y/2 y oo•ce,m BUILDING INFORMATION Existing Use of Building: >G,2 Contract Price of Work:$ '2 SO, 000, o© Proposed Use of Building: S�'� Heat Source: I IGas ❑Electric ❑Other BUILDING USE: EgSSFR (^Townhouse `:Duplex JADU EMulti-Family-#Units J•Commercial (_Accessory Structure Type of Project: KNew JAddition ^Remodel ❑Repair CT.I. -Sign L Sprinkler Demolition '-Change of Use DESCRIPTION OF WORK: f C/S7•, Se.-ye / 2$iDi2y /-/Ov_re /fr./7/7" . 777.9Gh'e4' jOT/�e C.os-7l1'iii��J�t3G �2e.Q 3 8/7 spi= 5-/3eo'c°'cs'-- ASSOCIATED BUILDING PERMIT#(if applicable): Amyb Y M ./ MECHANICAL PERMIT APPLICATION PL BING PERMIT APPLICATION Fixture Fixture Fixture ist of Fixtures Fixture Count Count List of Fixtur Count List of Fixtures Count ' of Fixtures A/C—Air dling Units Gas Pipi — Back? Preventer(Inside Bldg) / Sho ,Tub,or Combo Boiler !� Gas ange 2 Clothes Wa r -Commercial(3-comp,prep,floor) Clothes Dryer / eat Pump&Ductless / Dishwasher �7 Sink-Residential(kitchen,bath,bar) '� Duct System(Remodel Refrigeration -- Drinking Fountain 1Sink-Utility,laundry,mop .9 Exhaust Fans(Residential) Commercial Ventilatior .� Floor Drain ��///•g- Toilet Exhaust Hood(Type I) of Heat/AC system) 2 Hose Bibb �` Urinal Exhaust Hood(Type t Water R�'ater� — Interceptor-Grease /Water Piping Repair — Exhaust Hood sidential) Wood Stove Interceptor-Sand/Oil I Water Se i e(behind meter) Forced Air stems Other: — Medical Gas — Water Valves Fixtures Gas Fi lace/InserULog Roof Drains / Water Heater SPRI KLER/SUPPRESSION SYSTEM Sewage or 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 PERM# , ob 0 / y/ a00 V , '� t � (y)(.3 er/Authori gent Signature Date (Revised 10/10.'2018)