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PERMIT APPLICATION BUILDING •CHANICAL / PLUMBING / SIGN I•RINKLER/ DEMOLITION 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 PROJECT SITE ADDRESS: ,A / 3 6, c, u _ PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: J c-,-,•.c r2o, i� % S f- TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 3e>a L-i c fCt\ 1 t 5'3- 6 f ` CITY �' � 'L-�� 1-'� STATE ('' i� ZIP ' J-Z L/ OWNER PHONE: S`S 3 �- OWNER EMAIL: or�S CONTRACTOR NAME: � � c v_,y /R ., c ( "1 5 Lc, •� r1 C CONTRACTOR ADDRESS: STREET p,. C •/ STATE Lvim Ch ( 76 C� CITY �l Gl /\ , ( '� (,-'. �; ZIP / Z 74 CONTRACTOR PHONE: H ZS'-- `-I c(3. `i 7 2 i CONTRACTOR EMAIL:— CONTRACTOR LICENSE#(REQUIRED): L.r_C: t_ ;N b { k CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Y' 4 e. D PRIMARY CONTACT: ❑OWNER m CONTRACTOR ❑OTHER(Please Specify) So� �_- /` . CONTACT NAME: CONTACT PHONE: 2 O c.— S/0 5 .� ( �o r^(.1 r'n S CONTACT EMAIL: BUILDING INFORMATION Existing Use of Building: 5 f a- Contract Price of Work: $ / 1. `f - Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other BUILDING USE: SFR Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture List of Fixtures Fixture List of Fixtures Fixture List of Fixtures Fixture List of Fixtures Count Count Count Count A/C—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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and/comply with the State Contractors Law 18.27 RCW and 296.200A WA C. (} City of Everett Official Use Only PZ Owner/Authorized Agent Signature Date (Revised 10/10/2018)