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PERMIT APPLICATION■ BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION Noirwi CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (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 J PROJECT SITE ADDRESS: �815 2 i S g\IE 12(;TT- PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: S(J0(veg &zr by TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET �j I S .0I „$T ri'T 4 J sr 57 CIN 4Evoze rr STATE IA.1A ZIP OWNER PHONE: L125-55q-I-Cj -ict OWNER EMAIL: CONTRACTOR NAME: —j 72,1450cfjZ YZ C(;S L,(.,C CONTRACTOR ADDRESS: STREET /VA,3 S'i't ix,/".#4,e/ Pb /� CITY �/77/Ves/2' STATE '`j /A ZIP 9979e) CONTRACTOR PHONE: 61Z5-;',..516. Vie e CONTRACTOR EMAIL: 6 ,l, ,4L3)c , /)S(.GO/rt CONTRACTOR LICENSE#(REQUIRED): z/(��/L4 J .17/Ca CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): J'l 1g PRIMARY CONTACT: 0 OWNER ,ONTRACTOR 0 OTHER(Please Specify) 2 G CONTACT NAME: CONTACT PHONE: q Z S'"'" S�(o - (13 O Cop y A LIT XAtL( g- CONTACT EMAIL:ecei..reA(�= Not'IZC�i- pser.c U' BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ CMZ, GO Proposed Use of Building: Heat Source: dGas ❑Electric ❑Other BUILDING USE: SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: El Commercial ❑Accessory Structure Type of Project: CI New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: IZE 1,0cATTcx4 d= F TH Gchs �-rc 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 NC—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 Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior 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.1 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 wit e State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only i7- PERMIT#VcA.O- rlamO� Owner/Au orized Agent gnature Date (Revised 10/10/2018) `