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47-T PERMIT APPLICATION BUILDINL 7 MECHANICAL/ PLUMBING /SIGN /:,.-RINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES 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: //3Z Z fjif/4p I$ , ). PROPERTY TAX#: 43(3475992?90/700 LEGAL for new construction: Short Plat/subdivision fj4JL' 11?NO WO Lot No./7//8ttach copy of long legal description) CONTACT INFORMATION OWNER NAME:a/(jt A)ny )A.) a # 7 CR/SOW-ENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: I /�}3a. / , ,/^ m 0 STATE T ZIP 98�zzr OWNER PHONE: `l Z �2 ( Z - �� 2a OWNER EMAIL: r'Y1.6C "'f ler P p f 4.1 j; ` ,con CONTRACTOR NAME: OLL),fJ,4 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: (CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR MOTHER(Please Specify) CONTACT NAME: -1,2/Q y`S CONTACT PHONE: yZs 3Q7 S C) • CONTACT EMAIL: 66.150fL BUILDING INFORMATION Existing Use of Building: Sfi2 Contract Price of Work:$ 0 ' L o )0C7O Proposed Use of Building: Q4G (Heat Source: ❑Gas ❑ lectric ❑Other //Q/S( BUILDING USE: ❑SFR ❑Townhouse ❑Duplex LJADU ❑Multi-Family-#Units: ❑Commercial Kccessory Structure Type of Project: ❑New lAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ^},❑Deem'ollition ❑Change of Use DESCRIPTION OF WORK: comgrl�G�CI D)LJ AL26 `x 3 z i 1<t.c-Gt"c a /pC0) F/2i" 7 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 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/ 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/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. ''nn// /,/ Cityy oft Everett Official Use Only ,ram `0/6/7QZ/ PE f \ —C2g Owner/Authorized Agent Signature Date (Revised 10/10/2018)