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EVERETT <br />WASHINGTON <br />PERMIT APPLICATI <br />BUILDING/ MECHANICAL ! PLUMBING / SIG SPRINKLER / 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: ( 0 30 r., L� �� SC <br />1PROPERTY TAX #: 0076 Z30UC O ZZO 2- <br />LEGAL for new construction: Short Plat/subdivision Lot N42 (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: &-O v- \ef-s " ►M''E..S TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 2 <br />CITY MSIQS `1 ��� STATE G 2 P <br />L <br />OWNER PHONE: "IZjr� 2`to"2-t Z ! <br />OWNER EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />t ,, ^ <br />CONTRACTOR LICENSE #(REQUIRED): [-Q�-� 13 _Z0 I of �Z <br />`/ <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): % 7 <br />PRIMARY CONTACT: 40OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: / <br />C)�' <br />CONTACT PHONE: LA 2.S ZQv _2_1j Z9 <br />CONTACT EMAIL: <br />BUILDING INFORMATION <br />Existing Use of Building: S <br />lContract Price of Work: $ 2_4 2i 0 6 5- <br />Proposed Use of Building: S f )— <br />I Heat Source: EGas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: RI ?NNew ❑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 />H <br />IGas 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 (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 />/ <br />Exhaust Hood (Type II) <br />/ <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 />/ <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 />No. of Heads <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 com4with e State Contractors La 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />00 <br />Owner/Aut ized Agent Signatu ff Date (Revised 411512019) a <br />