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PERMIT APPLICATI �� <br />BUILDINVMECHANICAL / PLUMBING /SIGN SPRINKLER / DEM TION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />i 3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON _(P) 425-257-8810 1 FAX425-257-8857 1 (E) everettepsCa)everettwa.aov I www.everettwa.aov/oermits <br />(Blue or Black Ink Only Please) ' PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: ZOc, I i2pA L SE wA. <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: o - d TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET h W <br />CITY Ca <br />STATE ZIP R e <br />OWNER PHONE: 0 L - ?O ,. <br />OWNER EMAIL: aSon tCj , v" o <br />CONTRACTOR NAME: Co t <br />CONTRACTOR ADDRESS: STREET 17 6 Z `S� SlC 10 <br />CITY o � C STATE Vf ZIP 41 8>0 <br />uu <br />CONTRACTOR PHONE: " L Z5 - -t�`S ©(� <br />CONTRACTOR EMAIL: , RM C > '� cor. r o r� �1 Cc� <br />CONTRACTOR LICENSE #(REQUIRED): <br />TY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER (Please Specify) <br />CONTACT NAME: <br />T <br />CONTACT PHONE: 760 - ?o K <br />CONTACT EMAIL at o is <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of. Work: p©0„ <br />Proposed Use of Building: C* <br />Heat Source: ❑Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi -Family - # Units: ❑Commercial ` ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair LIT.[. ❑Sign ❑Sprinkler ❑Demolition of Use/ <br />1❑.._Change <br />DESCRIPTION OF WORK:�0'� <br />(� a 1�C.ew►Cti�" �G11� le. robs �� ��GGr++ti�,c�� S/0 ed , <br />i' _ P <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 Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen,bath,bar) <br />Duct System (Remodel) <br />lRefrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />I Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />Water Neater" <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 <br />No. of Heads <br />Chemical Suppression System <br />No. of Heads <br />ACKNOWLEDGEMENT ; l 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. / am the owner, ,or I am authorized by the owner of this property to perform; the work for which application is made, <br />and f comply with the. State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />5 / 2-0 FPSIMS <br />-0 �—.� <br />Owne q thor' gent Signature' Date` (Revised 1011012018) <br />�� <br />