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® PERMIT APPLICATIO In BUILDING ECHANICAL / PLUMBING /SIGN 1 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: if fO5 I / S% awn, td y02$ PROPERTY TAX#: LEGAL for new construction: short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: er &2 L)(J4D0 TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET //3Z1 ,ttl. cZ,4 )2 - / J CITY % �S/ i/ iJ / �/�,� STATE. /441-- zIP� 1//SL OWNER PHONE: L /- 7SD 005 OWNER EMAIL: 4eto(//�//�/ILTDF-S@#UT�4f Z• e-.94 CONTRACTOR NAME: (,J Mgpt 7//J eoD/4/ ' '' CONTRACTOR ADDRESS: STREET 'pc) ''> 3 '7/%S� ��(� CITY G /j frC STATE / / zip ' !, Z- CONTRACTOR PHONE: 9/�5 270 tS 27 CONTRACTOR EMAIL: f/c2SYS 7770 Z-, 4,' CONTRACTOR LICENSE#(REQUIRED):/t I f/f j/CT/'j 2(] CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) '` PRIMARY CONTACT: 0 OWNER P`CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: / Z , C 3-77 IA) CONTACT EMAIL: 77 BUILDING INFORMATION ------ -.....2) Existing Use of Building: Contract Price of We:$ i Proposed Use of Building: Heat Source: ❑Gas --❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: El New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: (N c a- 5 f-n_m OaS 7 )G � G/,/ -re � C� ' kM M/5T1 5�� D� `'' 7---(),-vA--C-F- .-re' Ek/S774/. ASSOCIATED BUILDING PERMIT#(if applicable): Alr`t 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 1 Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler I 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 PERMIT# 5e-Pri 3 j - 0/9 il\AR — q0 0 n/Authonzed A nt Signature D 0 e ate (Revised 4/15/2019)