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11111111 PERMIT APPLICATIO <br />0 BUILDINGRIECHANICAL / PLUMBING / SIGN�RINKLER / DEMOLITION <br />EVERETT 32CITY OF EVERETT PERMIT SERVICES <br />00 CEDAR STREET, EVERETT, WA 98201 <br />waSFllNcroN (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everettepsCeDeverettwa.gov I www.everettwa.gov/permits <br />(Blue or Bkm* Ink Only Phase) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: I Z M C' � S 0 <br />PROPERTY TAX #: �j(j <br />LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: t N N 15 )% LL C TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET _213 Ui S S\rj <br />Q <br />CRY jr { (' STATE W "' , ZIP <br />OWNER PHONE: C� �!�, C� - �j �I <br />OWNER EMAIL: (-e-L l 3 �ryl c t , C�, AA <br />CONTRACTOR NAME: <</ <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: I <br />`te e e- <br />CONTACT PHONE: - j () - s <br />CONTACT EMAIL: c cA✓I^- <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ • 0 <br />Proposed Use of Building: <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 ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: St-66 I- (ASS ✓ 10 `� C. VYL 0 � (,� _ I z� U a_tlr <br />V'6L(l Od tO �z '6 -lr G V✓\, u- f 'SQL � " <br />ASSIIOCIATED BUILDING PERMIT # if applicable): C-16 b — D� <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Count <br />List of Fixtures <br />Fwture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />ant <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 PumpBDuctless <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 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />lWater 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 />I <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER I SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other. <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />jNo. 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 />PERMIT # <br />1 I Z3 W 201 b-00 Signature Date (Revised 1011012018) <br />