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PERMIT APPLICATION BUILDING IECHANICAL/ PLUMBING /SIGN i RINKLER/ 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 PROJECT SITE ADDRESS: C4-07 J2J Je 1A9a y. Eve,/e et PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision (f Lot No. _ (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: M L{I l,L f..PJ- .. \_,e_AAAA: TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 1110 7 fQ of-e.. _IV a , , eva-rtbt, CITY G ],, STATE l t14- ZIP %ga J 3 OWNER PHONE: 20 1 �/" 3 OWNER EMAIL: mil, l.(.. ,1M �Y V1�.t 1 C41r �_. CONTRACTOR NAME: ,60/W /• (DIY r L CONTRACTOR ADDRESS: STREET ' l. „ 'AO Y�U CITY i1c, ,.., -'.7---- STATE tom/ Ar— ZIP C71 2^>_3 CONTRACTOR PHONE: ItT,11 b - 'CONTRACTOR EMAIL: CONTRACTOR LICENSEj REQUIREED) -) CITY OF EVERETT BUSINESS LICENSE CREQUIRB(........,,__ __,---• PRIMARY CONTACT: �1 OWNER CONTRACTOR El OTHER(Please Specify) CONTACT NAME:e !\ CONTACT PHONE: -LA01 3 -0 0-a pi(A f�06 L,e. 't, / CONTACT EMAIL: �._�'�'_ `� BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ ; p� 0 0 Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Ot er BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: \❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler llm„Alition ❑Change of Use DESCRIPTION OF WORK: 1 P(u WI 0 (0 c W C4+-eC-. s q OZ 1 k/1 P S -Pc r- (A -e-ut) s ILA ASSOCIATED BUILDING PERMIT#(if applicable): ( �� 5 N _�t MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Coynt 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 Ventilatior Floor Drain 1 Toilet t/' Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease i 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.-'.•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 ontractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 1• 0a -al - 7'2002 - 0 (42 Owner/Authorized,,-nt Signature Date (Revised 4/15/2019)