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® 0 PERMIT APPLICATION • il BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER / 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: 2 301 pi 4r 5r- = 1 PROPERTY TAX#:OOS'15 85o ZO it 00 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: �., j TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET -' U, /Z/ i / 4 4 �'r / S ' Z- ' a CITY S c; 0 JV i S ti n STATE LA) /' ZIP Ci S t� C`I 6 /v OWNER PHONE: A jv -3/�/ - G / 09 OWNER EMAIL: S f3 )?- k e.' r)L L/ i . o7L i!? S L IV( Cz- CONTRACTOR NAME: s 11 C ( 6 L T)L- , • CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 9'PRIMARY CONTACT: OWNER ❑CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:42S 3 • (40. VP `'j Li S i'C itj /Z( L / S /N J4 CONTACT EMAIL: Sgsr c' S rLG- BUILDING INFORMATION `,\ Existing Use of Building: Contract Price of Wo'k: Proposed Use of Building: Ir Ot'i egot9ai R2 Heat Source: ❑Gas Electric ❑Other Her Pull p BUILDING USE: I SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition Remodel 1gRepair T.I.❑ ❑Sign ❑Sprinkler ❑DemQiifion 1hange f,Use DESCRIPTION OF WORK: n e_ 1 L our.) Sec-no 1 SU)Li- w I�OUr "A rt17. 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 Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) \ % Shower,Tub,or Combo Boiler ,�tt�,� SIC s Range / Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer'-` �� at Pump .uctless Dishwasher , Sink-Residential(kitchen,bath,bar) ti Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility, laundry, mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 5,/,e PL{if i&—Q®t 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/Inse�,r,t/Lerg Roof Drains Water Heater SPRINKLER J-St/�PPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads ACKNOWLEDGEMENT:1 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 RMIT#,..2ricm 1 t / (3 if._ () Owner/Authorized Agent Signature Date (Revised 10/10/2018) w c4-og - Old 7,