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EVERETT <br />WASHINGTON <br />PERMIT APPLICATIO 5 <br />BUILDINGOECHANICAL / PLUMBING / SIGN�RINKLER / DEMO ITION <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: Z00 I iZDA ?L _ <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: <br />o - d TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY Ck <br />STATE W ZIP R g <br />OWNER PHONE: 8 ` ^ 70 19coo <br />OWNER EMAIL: � "., a < ,-O o <br />CONTRACTOR NAME: � o _'" <br />CONTRACTOR ADDRESS: STREET 17 6 2 t 57 SF �© <br />CITY l L' STATE ZIP <br />CONTRACTOR PHONE: qZ5-q$.'S- v�� <br />CONTRACTOR EMAIL: , Ra►C,> '� C r-% r � too <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ,OTHER (Please Specify) e, <br />CONTACT NAME: <br />CONTACT PHONE: 76O 70K % q% <br />) <br />CONTACT EMAIL: * �b o � � M <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ moo <br />Proposed Use of Building: cv <br />Heat Source: ❑Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi -Family - # Units: LC ❑Commercial ❑Accessory Structure <br />Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sppprinkler ❑1Demolition ❑Change of Use <br />DESCRIPTION OF WORK: `e. ►-obj Slo e/ , <br />ASSOCIATED ILDING 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 PumpBDuctless <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/InserULog <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />jNo. of Heads <br />Chemical Suppression System <br />I 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 / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />5Y 2-0 PER s w ►� <br />Ownrho gent Signature Date (Revised 1011012018) <br />1t <br />1'- <br />