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sem PERMIT APPLICATIO BUILDIN1PMECHANICAL/ PLUMBING /SIG PRINKLER/ 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) ! 0 PROJECT/ SITE INFORMATION PROJECT SITE ADDRESS: ,l/S 0L yrt}�/G Re"( PROPERTY TAX#: of?(1 o / '"ral"ox`OG LEGAL for new construction: Short Plat/subdivision 1/ 4 P iZ! .f>i,n TC fLot No. 6j (attach copy of long legal description) 4 f't�i,.'/ ONTACT INFORMATION OWNER NAME: /1r114'.l TENANT BUSINESS NAME(Commercial): Y�OS��,�art. / OWNER MAILING ADDRESS: STREET 7S 0 0L,�► t/ •mp'z ,15 ,,f CITY fr/,42,)J7 \ STATE /I/A ZIP Pf f OWNER PHONE: JO7 79/ 9/57 OWNER EMAIL: d prl LtA atl,.00 CONTRACTOR NAME: -7— 4,,_,A/4�—L.,, CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ),T 7,9/��73'',) /)a/1//i'' // /�'5I` 4`'\ CONTACT EMAIL: -,4r 6*Sf J�/az'�(`v g• '•C7'//.�GG L C BUILDING INFORMATION ` t —( ExistingUse of Building: / Contract Price of Work:$ l.2`l ` Ps e; er41-/a -.,tG� Proposed Use of Building: (c'r%`� lee(/`(I _C-6 /Z Heat Source: 9Gas ❑Electric DOther BUILDING USE:OFR ❑Townhouse ❑Duplex DADU Cl Multi-Family-#Units: ❑Commercial DAccessory Structure Type of Project: ❑New Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ��nrt?l I �Q Orro j• 6 d al,.�te /'di ,e061 & 2/ ASSOCIATED BUILDING PERMIT#(if applicable): 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 A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Co bo Boiler Gas Ranged Clothes Washer Sink-Commerc—comp,prep,floor) _ Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Si*IF-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain j'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/Ins Log Roof Drains Water Heater SPRINKLE SUPPRESSION SYSTEM Sewage E' or or Sump Pump Other: Water Suppression Sys m No.of Heads Chemical Suppression Sy tem 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!am authorized by the owner of this property to perform the work for which application is made, and omply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERM `] wner/Authorized Agent Signature Date (Revised 4/15/2019) f 1z_