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� PERMIT APPLICATIO <br />PRINKLER / DEMOLITION <br />BUILDIN ECHANICAL / PLUMBING / SIGN <br />, <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P)425-257-8810 1 FAX425-257-8857 1(E)everetteps@everettwa.govI wwweverettwagov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 0 14/ CZ&,_:�IAZO 1ZQjL,J fi`rr m[ PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Aj ItVilq)l TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET '01 ell- j /6 <br />CITY r t STATE UL,- ZIP . <br />OWNER PHONE:: - - 0 6 L <br />OWNER EMAIL: Vb oe / M <br />CONTRACTOR NAME:44U'_e ' e,1L' iC •4C IL <br />CONTRACTOR ADDRESS: STREET_ZgL <br />CITY j STATE i ZIP' — <br />CONTRACTOR PHONE: — 3—Tr' q/(► <br />CONTRACTOR EMAIL: ;./ f & 4rl <br />CONTRACTOR LICENSE #(REQUIRED): n/ 1V L c� " Z-P <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER gCONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />NTACT PHONE: W 6 _ c. L , t. <br />Fcc <br />NTACT EMAIL:1,��7/f"r i crL1c.� t,��✓ z <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: ❑Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ElTownhouse ❑Duplex LJADU Multi -Family - # Units: . ❑Commercial DAccessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair OT.I. ❑Sign ❑Sprinkler ❑Demolition ElChange of Use <br />DESCRIPTION OF WORK:-1f��t,J �G1f1�7 /RC r' tLt.�/y dj <br />A,-/m) i�� .rs,���=' �uac e� o3Err�� <br />j /3 �r/�j c' �� r t 7-JI) f4S' rlo& c a r <br />ASSOCIATED BUILDING PERMIT # if applicable): �`'�� ® ®ZDO 421FA <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Counr <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 />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 I) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type ll) <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 />er Suppression System <br />b <br />No. of Heads <br />mical Suppression System <br />No. of Heads <br />ACKNOWLEDG MEN 1: 1 have reviewed this application and confine 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 ofEverettOfficial Use Only <br />(Revised 1011012018) <br />