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EVERETT <br />WASHINGTON <br />PERMIT APPLICATIO ° <br />BUILDINAECHANICAL / PLUMBING / SIGN , RINKLER / 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) <br />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: �g I I <br />H iW If IT <br />A 1 L" • F <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: <br />TENANT BUSINESS NAME (Commercial): PA L <br />OWNER MAILING ADDRESS: STREET <br />l r`) tG V TT P, L � <br />CITY L t,f •' <br />C� / <br />STATE l)A ZIP <br />OWNER PHONE: C <br />OWNER EMAIL: <br />CONTRACTOR NAME: :- f �,� C` s`� I C-IA/ <br />r / <br />CONTRACTOR ADDRESS: STREET <br />P C Re x <br />(s <br />CITY <br />`L_ v L ( <br />7 t <br />STATE w `� ZIP <br />CONTRACTOR PHONE: 1, I %i `� - 3 ( <br />CONTRACTOR EMAIL: & . ? <br />CONTRACTOR LICENSE #(REQUIRED): <br />LC- A % 0 (- <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED . 3 3�G <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />' /M7 l`'?4lvtjl <br />ACT PHONE: ii 3I - % 3 <br />LONT <br />NTACT EMAIL: ) Lk � 11, ) MA 'N 15 on `%fl H0D D. <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: � <br />Heat Source: EIZGas El Electric []Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family -# Units: ©Commercial ❑Accessory Structure <br />Type of Project: New ❑Addition ❑Remodel ❑Repair <br />❑T.I. ❑Sign []Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: ���I LL N�ul� i�j.Q� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />SY S ��� PRD lax �l r1�C ->Y5'i (% <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 />I <br />IRoof Drains <br />lWater Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />other: <br />Water Suppression System <br />I No. of Heads <br />Chemical Suppression System <br />v I <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. I 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 />0C; (7 2o3 <br />orized AgenWgnature Date <br />City of Everett Official Use Only <br />PER T <br />I <br />(Revised 411512019) <br />