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EVERETT <br />WASHINGTON <br />PERMIT APPLICATIO <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) ROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 4.2—F t" 4 _ <br />I 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): <br />OWNER MAILING ADDRESS: STREET <br />CITY <br />STATE ��/7 <br />ZIP ( Gt <br />OWNER PHONE: 4ZS — <br />OWNER EMAIL: <,h Seri gUr(� k <br />CONTRACTOR NAME: s io <br />CONTRACTOR ADDRESS: STREET .J Z <br />CITY A/u J <br />STATE <br />ZIP <br />CONTRACTOR PHONE: [k2 - Z <br />CONTRACTOR EMAIL:,r <br />O` <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: .V OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ f/� V <br />? <br />Proposed Use of Building: <br />I <br />Heat Source: WGas ❑Electric ❑Other <br />BUILDING USE: 4SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial <br />❑Accessory Structure <br />Type of Project: aNew ❑Additi n ❑Remodel ❑Repair <br />❑T.l. []Sign ❑Sprinkler ❑Demolition <br />❑Change of Use <br />DESCRIPTION OF WORK: �NS {U 1 /V% A1eV.7 HoMef, <br />BUILDING PERMIT # (if applicable): <br />-ASSOCIATED <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATMA <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtur <br />Fixture <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C —Air Handling Units <br />I <br />Gas Pi ' <br />-Count <br />I <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />i <br />G ange <br />( <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />/ <br />Clothes Dryer <br />eat Pump&Ductless <br />I <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 (Residentia <br />Commercial Ventilatio <br />(Not Heat/AC system) <br />Floor Drain <br />3 <br />Toilet <br />Exhaust Hood (Type <br />Hose Bibb <br />Urinal <br />Exhaust Hood (T e II) <br />1 <br />Water Heater <br />Intercepto ','lease <br />Waste/Water Piping Repair <br />Exhaust Hopd(Residential) <br />Wood Stove <br />Inter tor-Sand/Oil <br />I <br />Water Service (behind meter) <br />1 <br />Forced Air Systems <br />Other: <br />Mcedical Gas <br />Water Valves or Fixtures <br />Gas-fireplace/lnsert/Log <br />Roof Drains <br />Water Heater <br />PRINKLER / SUPPRESSION <br />lWatefSuppression <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />System <br />No. 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 />a/l '�Vomply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERM <br />Ca I� -(i <br />Agent Sig ature Date (Revised 411512019) <br />1% 1 <br />