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IP PERMIT APPLICATION 12 BUILDING / MECHANICAL I PLUMBING I SIGN i SPRINKLER 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 1 www.everettwa.gov/permits (Blue or Black Ink.Only.Please) PROJECT'SITE INFORMATION .. ' .... PROJECT SITE ADDRESS:/q/ 1 9_ rft6j%k yxr PROPERTY TAX#:Oa7GI94'—ZZ7-bi 7•-d? LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) . • :• • CONTACT INFORMATION: . .. OWNER NAME:/0.71/ /ill e(C-fLZ y TENANT BUSINESS NAME(Commercial): t 4 OWNER MAILING ADDRESS: srReEr��/6 /Z <,��/ ��T cite - t -fic STATE 4.//41 ZIP 9re.4r OWNER PHONE#e G.__-.5--.. - :.-/.._.,....... ._... _,OWNEREMAiL:: hi1cla�s"�lf r✓ / C-0 , CONTRACTOR NAME: ,0u)Ai Vt. CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: flY,OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: </. 5 e7G—5-'9y9 /1 a/ems!'// `4 //I, CONTACT EMAIL:� L 0 7�as f;e _ -:'SUIIrOING'iN1=GRMATiON Existing Use of Building: _.5- %/Z Contract Price of Work:$ Proposed Use of Building: 5.--/n Heat Source: ❑Gas XElectric DOther BUILDING USE: yISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: DCommercial ❑Accessory Structure Type of Project: El New DAddition ❑Remodel gRepair DT.1. ❑SIgn DSprinkler ❑Demolition DChange of Use DESCRIPTION OF WORK:eit9ry �o }(,�% /✓6i'141164sC ASSOCIATED BUILDING PERMIT#(if applicable): ... MECHANICAL_PERMIT`APPLICATION PLUMBING PERMIT APPLICATION ';; Fixture Fixture Fixture Fixture Count L.kt of Fixtures Count List of Fixtures Count Lisf of Fixtures Count List of Fixtures NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) / Shower,Tub,or Combo Boller / 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 Ventllatior Floor Drain / Toilet Exhaust Hood(Type I) (Not HeaUAC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater interceptor-Grease Waste/Water Piping Repair Exhaust Hood(ResidentlalY Wood Stove Interceptor-Sand/Oii Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER!:SUPPRESSIONSYSTEM •• 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 1 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 16.27 ROW and 298.200A WAC. City of Everett Official Use Only PERMIT# /2/2.(2, Vic. ,e ZaOR -oOl Owner Authoriz d Agent Signature (Revised 4/15/2019)