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mom i PERMIT APPLICATI mi BUILDIf�A1�/ MECHANICAL/ PLUMBING /SIG PRINKLER/ 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: Ill/ ,e p, ta4...r l ,jCl 7 f— fi/4- PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision C' Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 1)(2D1441/r/2(/ ,qic(L. TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET IUUC, 1l>r,,t b/4- 7/ A1/A� CITY - STATE t.2/,4_- ZIP qsto OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Z2Z%////%( /fr 6€'J ( L_- CONTRACTOR ADDRESS: STREET (/;/j4..2 i(//74k/ Ai)t< CITY /�r ^"� STATE/- ZIP 101,0 3 CONTRACTOR PHONE: CONTRACTOR EMAIL: ,/�.F f7 6 /fQj/ jL ' [©,- CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING INFORMATION Existing Use of Building: --It-,- • Contract Price of Work:$ ?h C) Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: SFR ❑Townhouse ❑Duplex 0U ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remmo�del • Repair /�❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: /�N"`C�C , 61064//it/6— -"C%#1f7 4J&— - 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 CO 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 X Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain p 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 PERMIT# —C ' •0.�//- � ?2th — 0f0 wnerlAuthorized Agent Signature Date (Revised 4/15/2019)