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EVERETT <br />WASHINGTON <br />PERMIT APPLICATIO <br />BUILDINAECHANICAL / PLUMBING / SIGNOPRINKLER / 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) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACTINFORMATION <br />OWNER NAME: (� _'--;-( i��if �(,�1YiC/ TENANT NAME (Commercial): <br />//BUSINESS <br />OWNER MAILING ADDRESS: STREET 4P ��C/C <br />( V eg - CITY V `' STATE Iq 21 ZIP <br />OWNER PHONE: ©� — � — `Z Z� OWNER EMAIL: Ci�(S /YIi {, S01 M <br />CONTRACTOR NAME: C/ <br />CONTRACTOR ADDRESS: STREET r� • �dG (�(� Y %I V <br />p <br />CITY V �y STATE Vj ' ZIP q 2li <br />CONTRACTOR PHONE: oL4�p -- / — 22 <br />CONTRACTOR EMAIL: �'JdS /n'I e Sq/,I ✓J2 <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: / /, ,,,/1 <br />OL. U ����/ W tF �•rU ��ii/%� <br />YY <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING INFORMATION <br />Existing Use of Building: /Yl ! <br />Contract Price of Work: $ <br />Proposed Use of B lding: ",bqj� <br />Heat Source: ❑Gas ❑Electric ❑Other <br />BUILDING USE: SFR ❑To nhouse ❑Duplex ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New 10Addition El Remodel ❑Repair ❑T.I. ❑Sign []Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: f f 6 s, <br />ASSOCIATED BUILDING PERMIT # (If a licable): lea <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 />Shower, Tub, or ombo <br />A/C — Air Handling Units <br />>I <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Co rcial (3-comp,prep,floor <br />Clothes Dryer <br />Heat p&Ductless <br />Dishwasher <br />S k'Residenti I ( bath, r ' <br />Sink -Utility, lau op <br />Duct System (Remodel) <br />efrigeration <br />Drinking Fountain <br />Exhaust Fans (Residential <br />Commercial Ventilatior <br />(Not Heat/AC system <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type <br />Hose Bibb <br />Urina <br />Exhaust Hoo ype II) <br />Water Heater <br />Interceptor -Grease <br />aste ater Piping Repair <br />Exhau ood (Residential) <br />Woo o <br />Interceptor -Sand/ <br />Water Service (behind meter) <br />Water Valves or Fixtures <br />For6ecl Air Systems <br />Oth <br />Medical Gas <br />Gas Fireplace/InserULog <br />Roof Dr s <br />s 4iage Ejector or Sump Pump <br />Water Heater <br />Other: <br />SPRINKLER / SUPP N SYSTEM <br />Water Suppression System <br />I No. of Heads <br />Chemical Suppression System <br />No. of Heads <br />ACKNOWLEDGEMENT: I have review ;)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 ranting 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 authorizender any circumstance. 1 am the owner, or 1 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 />Owner/Authorized Agent Signature <br />/ City of Everett Official Use Only <br />/� PERM O — <br />"l (Revised 411512019) <br />