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%Ma-A PERMIT APPLICATIOt UILDING i MECHANICAL I PLUMBING / SIGN I ITPRINKLE" 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 PROJECT SITE ADDRESS: s' A ,, , lAJAL1 G Z-e;iT PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision U/ Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: ,iy/7 ,:TcA U/(p c ziLC TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 4//7/ /e056 bclA9 E14.) T7 CITY v STATE t, ZIP #` - ��4 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ,'_ )///ftj 1 ./(1' CONTRACTOR ADDRESS: STREET L/7/ fea 644.4 CITY c-z 1 l STATE tt,A_ ZIP 9S))/C'i CONTRACTOR PHONE: (1-/2s7 3S ZT 9 CONTRACTOR EMAIL: ,? -L' C^ //cT//A- cc/Cy CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: ,5 ' ,Y� CONTACT PHONE: v6y(`( / CC A-KI CONTACT EMAIL: Q./.?„.:1).1556---c.).") �)F-( .lei C. (167 imi L ' La," BUILDING INFORMATION 00 Existing Use of Building: ,2F/J,)/E(. Arc.%.06-4)/ Contract Price of Work:$ , '/� - '-'-c9 350. Proposed Use of Building: /A/ 6( /--4/L//C •(- Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: M om/yA6a /,�`t /ap`,j( It e 4 10 ASSOCIATED BUILDING PERMIT#(if applicable): ""�_��/��'��,��' — Via-740Coef2j�/l)tG'(i ctL ) 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 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 2 �,.-_ PERT(,,I,(. 3_60,i Own /Authorized Agent Signature Date (Revised 4/15/2019)