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El <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 4-- �1%� <br />PROPERTY TAX #: Z 0, C% <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />!All <br />OWNER NAME: d elL- <- vV t� {��� TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 2� U <br />(2`^/J <br />�Jk1t CITY (/ V T'j • STATE ' 8'2-0 ZIP <br />-7 <br />OWNER PHONE: r/ '2 " 75 -7� — <br />OWNER EMAIL: oC' C 1 �rh (tee_ r7' S L?sA , c&-k, <br />CONTRACTOR NAME: Z'L 'L v5 <br />CONTRACTOR ADDRESS: STREET it lYtlyl�2 F� 2 , <br />n f_ <br />CITY �. 'Y� STATE v V / - ZIP 2 Z CJ <br />CONTRACTOR PHONE: �jU ^ 52 — 00 <br />\ <br />EMAIL: AjiGil2 /��z� CO�tIS !`h(�iO.J •Gil •1� <br />LCONTRACTOR <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): S ZZ <br />PRIMARY CONTACT: ❑ OWNER g-CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: �J�J z JZ� ��st J <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING INFORMATION <br />Existing Use of Building: j ,1 S tA*0,J <br />J <br />Contract Price of Work: $ <br />Proposed Use of Building: On% <br />Heat Source: ❑Gas Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: klCommercial ❑Accessory Structure <br />Type of Project: %New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: `J C <br />1 ��" lra � �'L -1 .y�S, z � l�C:�i/'L � r�/� �'(.✓i � 'r <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C —Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System I <br />INo. of Heads <br />Chemical Suppression System <br />No. of Heads <br />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 <br />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 <br />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, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />�4, IT tcq p —off, <br />Owner/Authorized Agent Signature Dat (Revised 0/ 012018) <br />