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PERMIT APPLICATIO <br />BUILDINGOECHANICAL / PLUMBING / SIGN�RINKLER / DEMOLITION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (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 Pleas®) ' PROJECT SITEANFORMATION, ' <br />PROJECT SITE ADDRESS: <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />ORMATION <br />CONTACT INF11- <br />OWNER NAME: �OyU COI.I''v`� (h(fi TENANT BUSINESS NAME (Commercial): tµLDlal`/iliiPtS <br />OWNER MAILING ADDRESS: STREET <br />CITY v�� STATE W+f� ZIP 1 a ✓�� <br />OWNERPHONE: 41A•120r7• 011ie(, <br />OWNER EMAIL: tittf+JTOMbS& Lx<.* ". COWL <br />CONTRACTOR NAME: — ^iV $ tv <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER (Please Specify) OV006-f- of &X JT_ <br />CONTACT NAME: t4 *VYfAw ft:Q- 4b t_D <br />CONTACT PHONE: <br />CONTACT EMAIL: S^FQ( Q.�NM�S , Gpyv1 <br />BUILDING INFORMATION <br />Existing Use of Building: 1RV6T,i u4-''E'3'I_ Contract Price of Work: $ 0 <br />Proposed Use of Building: tJD l� t/ Heat Source: ❑Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ZCommercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />t,VA�OV-- vls" 'TA. -- t rl -1,Vo4Zj:�.l Vj"Vf� S VEe-Of . tAGvJ r Z t—J%A <br />�Nt'S�li � �i,F �iLti� Y—tOSYf� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />`APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List o res <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List ixfures <br />A/C — Air Handling Units <br />Ga i ing <br />Backflow Preventer (Inside Bldg) <br />Show or Combo <br />Boiler <br />s Range <br />Clothes Washer <br />' k- ommercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />nk-Residential (kitchen,bath,bar) <br />;720 <br />1 Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residentio <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type <br />Hose Bibb <br />Urinal <br />Exhaust Hood (T II) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood esidential) <br />Wood Stove <br />Interceptor -Sand/ <br />Water Service (behind meter) <br />Forced Air ystems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas F place/Insert/Log <br />Roof Dr s <br />Water Heater <br />SP KLER / SUPPRESSION <br />SYSTEM <br />S ag jector or Sump Pump <br />Other: <br />Water Su?ession System <br />No. of Heads <br />Chemol Suppression System <br />No. of Heads <br />ACP(NOWLEDGEMENT: 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. / 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 />Agent Signature <br />City of Everett Official Use Only <br />r (` <br />(Revised 1 /10/2018) X2— <br />