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PERMIT APPLICATIONOren. BUILDING / • I CITY OF EVERETT PERMIT SERVICES /SPRINKLER/ DEMOLITION 3200 CEDAR STREET,EVERETT,WA 98201 (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: IVA., �d , �iJl • PROPERTY TAX#:t' 2.2 cceoc 3 LEGAL for new construction: Short Plat/subdivision / 4 -T[�r/t Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 6(4.1404tepii C04.414T'( 414t? TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 2$21) CALAfottl...1(h CITY �\Italtelsr. STATE WA-. ZIP S OWNER PHONE:et-2591,- OWNER EMAIL: 5aw4al-404434d. • .cow CONTRACTOR NAME: L• j.�. I L 0 CONTRACTOR ADDRESS: STREET go 6 O" CITY ` O t/1 VIA—ill STATE • ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: v l Coo ") 251 I bit CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 551 Z'2-) PRIMARY CONTACT: kyrOWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: (4.2�) z31 —'goat: �� 1 P014,1/41,17 CONTACT EMAIL: a}1ti.�� at 4 Q SNo d .C.O>NA. J BUILDING INFORMATION Existing Use of Building: 1..4.-N Contract Price of Work:$ 040a•� Proposed Use of Building: 'rGAd4 T' h-(ii(r.j'TY _Heat Source: ❑Gas DElectric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: NCommercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel %Repair ❑T.I. ❑Sign Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: 12-;rAt . ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture List of Fixtures 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 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 tate Contractors L w 18.27 W and 296.200A WAC. City of Everett Official Use Only 04,5-17 PERMIT 10,1010-1 - D Owner Authorized Agent Signature Date (Revised 10/10/2018)