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EVERETT <br />WASHINGTON <br />PERMIT APPLICATIO <br />BUILDINGAECHANICA , / PLUMBING / SIGN�PRINKLER / 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: L'.' I t. ti'�\Gav\ VX e Q e. t/, <br />PROPERTY TAX #: S 1-100 tuuS60 <br />LEGAL for new construction: Short Plat/subdivision ! e�- Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: \j' i1. t 3't'� TENANT BUSINESS NAME (Commercial): 1� Lve./Z�1 ti <br />OWNER MAILING ADDRESS: STREET ^' 5 <br />1 q <br />CITY �CYv' of j;y.art.. - STATE C.! ' ZIP <br />OWNER PHONE: 0 > S 7 • G'11 o <br />OWNER EMAIL• S•y J ram; (_,Z 6> iF i <br />CONTRACTOR NAME:, <br />CONTRACTOR ADDRESS: STREET <br />CITY y� STATE Ivi ih ZIP <br />CONTRACTOR PHONE: k $5 ( 2 - <br />CONTRACTOR EMAIL: L L A L,L 134lNC- Loll, <br />CONTRACTOR LICENSE #(REQUIRED): y- <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): ,.Z t `1 <br />PRIMARY CONTACT: ❑ OWNER 54 CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: 2.r 6 Ig 57( -2'j 5)S <br />CONTACT EMAIL: ;� j�e' C C jtLL��1 N� • L. ,� <br />BUILDING INFORMATION <br />Existing Use of Building: .• ,, 'wk.,,r t, -V) <br />Contract Price of Work: $ <br />Proposed Use of Building: 5 v.vv\c <br />Heat Source: ❑Gas PgElectric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse [-]Duplex ❑ADU r)dMulti-Family - # Units: Z`- ` ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel (Repair LT. 1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION O1F,WORK: 0 _ <br />1�J�h'l�� Y'L��✓S � 6)�'`\/�✓!✓\`\ I \ l•W►W\ii► , \G�\ah+iVl•� � �av�� �'1 CFI✓ +�' (c v�`�r� <br />QAw+ri ! F `-t <br />ASSOCIATED BUILDING 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-cornp,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 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <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 / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />I <br />jNo.ofHeads <br />Chemical Suppression System <br />I <br />I 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 5tc1te Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PE C)q - 1 9 <br />Owner/Authorized Agent Signature Date (Revised 1011012018) , <br />7 <br />