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0 PERMIT APPLICATION • <br />VW BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />EVERETT 32CITY OF EVERETT PERMIT SERVICES <br />00 CEDAR STREET, EVERETT, WA 98201 <br />WASFIING"rON (P) 425-257-8810 1 FAX425-257-8857 1 (E) everetteps@everettwa.gov l www.everettwa.gov/permits <br />(Blue or Black lark Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: O <br />PROPERTY TAX M <br />LEGAL for new construction: Short Plat/subdlvision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: A" In rn 1 Y' TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET Ql c-6` <br />(//�► <br />CITY STATE ky %QC ZIP G <br />OWNER PHONE: BIZ ^ 5 0 - SaA 1OWNER <br />EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />CITY �,✓ %iZ c-tr- STATE t.t.1ko-- ZIP <br />CONTRACTOR PHONE: 2a) '2 SZ - / l CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): 6-V -"65C'2,-WT <br />CITY OF EVERETT BUSINESS LiCENSE #(REQUIRED): 00 -7 9 SS <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ® OTHER (Please Specify) <br />CONTACT NAME: <br />�/hari 5s-c, 6jwnn eis <br />CONTACT PHONE: ((.p z5-3 505E: 0 7Z3- <br />CONTACT EMAIL: QI,Y j ssc. SSI•yTv-t <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: E]Gas POElectric ClOther <br />BUILDING USE: CISFR ElTownhouse ❑Du lex OADU ❑Multi -Family- # Units: )k1Commerclal E]ACCesso Structure <br />Type of Project: ❑New ElAddition ❑Remodel ❑Repair $aT.I. ❑Sign []Sprinkler ❑Demolition ❑Chan a of Use <br />DESCRIPTION OP WORK: A"{ <br />�� w t�, � t_ „a4 , fin Y ,.. 3 <br />I PA �� ` � LEI 11-eZ� <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANiCAL PERMIT APPLICATION <br />Fixture Fixture <br />Count List ofFlxtures oount List of Fixtures <br />PLUMBING PERMIT APPLICATION <br />Fixture Fixture <br />Count List of Fixtures Count 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 (I(Itchen,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 />I Floor Drain <br />Toilet <br />Exhaust Hood(Type I <br />Hose Bibb <br />Urinal <br />Exhaust Hood Type 11) <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 />I <br />Roof Drains <br />Water Heater <br />SPRINKLER <br />I SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />17 <br />of Heads <br />Chemical Suppression System <br />I <br />No. of Heads <br />ACKNOWLEDGEMENT., I have reviewed this application and confirm the informallon 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 Officlel 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Offlcial Use Only <br />PERM T <br />Owner/Authorized Agent Signature Date (Revised 1011012018) <br />