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EVERETT <br />WASHINGTON - <br />PERMIT APPLICATIO <br />BUILDING'RECHANICAL / PLUMBING / SIGN / jPRINKLER / DEM LI ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 i (E) everetteps@everettwa,gov I www.everettwa.gov/permits <br />(Blue or Black lnk.Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: Zoo riZDA YL <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: oH04 TENANT BUSINESS NAME (Commercial): 0.9 <br />OWNER MAILING ADDRESS: STREET r <br />CITY <br />STATE ZIP 8 <br />OWNER PHONE: 0 C — 70 C _ S600 <br />OWNER EMAIL: + aSan d < CC <br />CONTRACTOR NAME: CO T n a o <br />CONTRACTOR ADDRESS: STREET 17 6 Z , k5W SF ' <br />,10 <br />CITY I� G` STATE ZIP 0190 <br />CONTRACTOR PHONE: 1-f2-5 <br />1 <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(RE D): 4ES 101 k CITY OF EVERETT BUSINESS LICENSE #(REQUIR ): <br />PRIMARY CONTACT: ❑ OW OTHER (Please Specify) <br />CONTACT NAME: <br />7h2'0"t �I <br />CONTACT PHONE: 7CO _ 70G( .. % C(7 <br />CONTACT EMAIL: * o c o-, <br />is i 1 0 <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ 'f© (4©0 <br />Proposed Use of Building: C_b <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 ❑T.I. ❑Sign ❑Sprinkler ❑jDemolition ❑-..Change of Use > <br />DESCRIPTION OF WORK: te. r'Bb� i� `iC.Gw+to�,c� , Sloped, <br />11 � 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 />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 I) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type ll) <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 />Roof Drains <br />Water Heater <br />SPRINKLER <br />% 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.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 />City of Everett Official Use Only <br />PERKZ �s <br />8/ 2 <br />\e tho gent Signature Date (Revised 1011012018) h <br />1' <br />