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MINI PERMIT APPLICATION BUILDING / MECHANICAL I PLUMBING /SIGN I 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) PROJECTg� SITE INFORMATION PROJECT SITE ADDRESS: .,1 3 O 9 PL'nk S l PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: SLR K 1 I 1 >`c T S 02, 16)L TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 4.1 6/4,) /LJ(jam t/ G 5 t `� CITY d STATE Lu 1 ZIP C1 �^o-' OWNER PHONE: d a_5 — 3I — Cs )09 OWNER EMAIL: S (3Id2K® O o L III 6 LUS I lU�-' C t fl CONTRACTOR NAME: SU K H m cg / s 43 f Xi( D 1636.061) rj 1 oR OCT )a IV CONTRACTOR ADDRESS: STREET 1 0© i i i 3 �IQ V L s, E �7 CITY C u b T L T T T- STATE Lt., r ZIP 9 G L CONTRACTOR PHONE: 4as-319- 01 0`f CONTRACTOR EMAIL: 5 8I e'KO b 1L/W PLO S N C' C f r1 CONTRACTOR LICENSE#(REQUIRED): pPGON Pc- '27 "I 81 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: Er."—OWNER ❑CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: S LI k j 07 t E 1 c. A I&K CONTACT PHONE: n j— 3 1 CJ —cp l ei cl CONTACT EMAIL: S O4-- ) 1C Cd �C.,ce_ g 'L U S 7 i'C' Cm_? BUILDING INFORMATION Existing Use of Building: 5 1 iv(, L C /_ cLirfrL X y Contract Price of Work:$��6i OidiYf)� �6' Proposed Use of Building: S1,yt �� Heat Source: ❑Gas g lectric ❑Other BUILDING USE: 'SFR ❑Townhot] a ❑Duplex DADU ❑Multi-Family-#Units: El Commercial DAccessory Structure Type of Project: El New DAddition ❑1Temodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTIONo OF WORK: .� p ,_L_/��_ , Q,, ex_._ jam, Z a -..t..l C )00 4 ._00 a-wo)cJPc-7 ) t1- �-'"', e., r/(f�''`' 3 / .441 t+ ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) I Shower,Tub,or Combo Boiler Gas Range I Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless ;ram$ Dishwasher Sink-Residential(kitchen,bath,bar) 2 Duct System(Remodel) sr Refrigeration Drinking Fountain Sink-Utility,laundry,mop .N/ Exhaust Fans(Residential) Commercial Ventilation Floor Drain .12, Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) !1 Water Heater Interceptor-Grease Waste/Water Piping Repair 1 'f 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 )PO) 19 PERMIT# Owner/Authorized Agent Signature Date (Revised 4/15/2019)