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mil PERMIT APPLICATI' ', c BUILDI I MECHANICAL I PLUMBING /SIG / SPRINKLER I 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 At PROJECT SITE ADDRESS: o22/ 04-,eES / / E4!(7CL'/I/,' PROPERTY TAX#: 0e)y39/ "2I VYQD LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION -1'OWNER NAME: TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET , �, /02 V'V w7e CITY �.�s7:4/ STATE ZIP 8�p G OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ,_s--el� CONTRACTOR ADDRESS: STREET I9a ,QX /2 J CITY --‘U��C STATE h/42.5Z ZIP :Cj?0‘ CONTRACTOR PHONE: 5 5:'y3-, ', CONTRACTOR EMAIL: -L9- CONTRACTOR LICENSE#(REQUIRED): - CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: El OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: y�5-_Sy�---c72&,2g ///�� ,��14/r1/ CONTACT EMAIL: BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse 0 Duplex ❑ADU ❑Multi-Family-#Units: El Commercial ❑Accessory Structure Type of Project: ONew ❑Addition DI Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Jere of -ili cl . i.i ITtuit. ASSOCIATED BUILDING PERMIT#(if applicable): Zb 2 i)O 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 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 I 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 �3 -NO °DL-\ /7 PERMIT# Owne/ uthorized Agent Signature Date (Revised 4/15/2019) '/