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0 PERMIT APPLICATIO16 <br />BUILDING /MECHANICAL /PLUMBING /SIGN /SPRINKLER /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 Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: <br />PROPERTY TAX #: <br />ILE GGAA .-. n8 st.-LIctii-.:,. .-! ui-, ram!-..,_.,. ..:�-t-._ <br />.vr.� fur iii;Vi Cvn�u i,uuun. w�u�. i-!oii�uuu!vl�!�n ! !.�. �aiiai:n i.uNy u! !i:iiy !cya! unptivi!r I <br />CONTACT INFORMATION <br />OWNER NAME: TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 2� c L ►.� }�� , , ;- <br />CITY t;:QIF- 2-�_'� STATE l7''96, zip <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: \Z: A �-� « c_ <br />CON T RACTOR ADDRESS: STREET E �� 1 `F IZ 5 r�._j C ._ <br />CITY V� l �� STATE W ZIP 9Z•� V <br />CONTRACTOR PHONE: L -Z-� `-t�-f I— i c5 3 <br />CONTRACTOR EMAIL: ,c4 <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED <br />PRIMARY CONTACT: Q OWNER ® CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />kA Etch_ � E�-� , ��� <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $— <br />Proposed Use of Building: O'F F-, L_ <br />Heat Source: []Gas ®Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: QCommercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: — <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-comp,prep,floor) <br />Clothes Dryer <br />"Z. <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 Ventilation <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <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 />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 />INo. of Heads <br />Chemical Suppression System <br />I <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 WAG. <br />Signature <br />01 <br />City of Everett Official Use Only <br />PERMIT # <br />YT\ � t _ D LA to <br />(Revised 1011012018) _- <br />