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PERMIT ° PPLICATI n <br />BUM LI DA MECHANICAL / PLUMBING / SIr . PRIiNKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />It ICE 7 T 3200 CEDAR STREET, EVERETT, WA 98201 <br />WARHI N(TC)N (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or BRock Rnk Ongy Plleas(e) PROJECT SITE INFORMATION — <br />PROJECT SITE ADDRESS: a TA' i <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONITACT fiNFO MAIJ JOh9 <br />OWNER NAME: %� ,s Ste. �� %1•� c. TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 72/ 2S— <br />CITY �', iJ p pj rn ! L STATE t li. iZ ZIP I ' C:, <br />OWNER PHONE: V LS-- 7_5-0'- s'C7s"' <br />OWNER EMAIL: 7-0.? cCS"P.wo <br />CONTRACTOR NAME: 6-c)x2y 4�- <br />CONTRACTOR ADDRESS: STREET 39v 7 <br />CITY L'� v :+ r r' %T STATE 4w4r, ZIP <br />CONTRACTOR PHONE: /1 s'- 2S— 7 -Gry J y `7 <br />�-7 <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER O"CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: ; <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 ❑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: <br />%�.� .y f Jn � r.-m-t i %� T Y v.� ��i ..f J 1 L` t' �-i f' % 7- 1J J.� �..5' /. , .� �; �`'i�� �7 s' .ter 'f' >^ -t�i,� J ✓ter �� L L !i <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL_ <br />.PERMIT <br />APPLICATI0N <br />PLUMOING 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 />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />I 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 />WasteMater 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 <br />/ SUPPRESSION <br />SVSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />_ <br />Chemical Suppression System <br />No. of Heads <br />ACKNOWLEDGEMENT.- / 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 l comply with the State Contractors Lgw 18.27 RCW and 296.200A WAC. <br />Owner/Authoriied Agent Signature <br />Date <br />City of Everett Official Use Only <br />PERMIT # <br />iy <br />if Revised 4/15/2019) i <br />