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PERMIT APPLICATtO <br />BUILDIN&ECHANICAL /, PLUMBING / SIGN'NPRINKLER / DEMOLITION <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) everetteos(q-)everettwa-oov I www-everettwa nnv/nPrmits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: �J Cvj&LTgWLjTPROPERTY TAX #: <br />LEGAL for new constriction_ Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: ,51*� 4 " , `r TENANT BUSINESS NAME (Commercial): SIf CeA/5VI CCU/ 114— <br />OWNER MAILING ADDRESS: STREET - / /� ,v �q,i 3�� 5 <br />CITY r` ' STATE ZIP <br />OWNER PHONE: �j �'(r, % '- .�Ci (z, c <br />OWNER EMAIL: V/ /t .4 <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET S c,c' <br />CITY ' — <br />C STATE h ZIP <br />CONTRACTOR PHONE: — 3 . r' —q T -76 <br />CONTRACTOR EMAIL: / f ii �i - f <br />CONTRACTOR LICENSE #(REQUIRED):Anceavc. <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED) o C <br />PRIMARY CONTACT: ❑ OWNER gVCONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL:r,/�/ l rL rc�a t� i.✓ L i Cc: C c .� <br />BUILDING INFORMATION <br />ExistingUse of Building: <br />9� <br />Contract Price of Work: $ r' <br />Proposed Use of Building: <br />Heat Source: ❑Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi -Family - # Units: ❑Commercial ElAccessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair EIT.I. EJSign OSprinkler ❑Demolition OChange of Use <br />DESCRIPTION OF WORK: re-rs�Oc- tr 0/(,v ,/��I�Frr.� I /1 e�014( r' <br />13(l// d / ► 1(Z e r%4C <br />� tRS�rrr4„►.7 kjs A, r_ T-- d zap <br />ASSOCIATED BUILDING PERMIT # if applicable): 6�?P.dL OA eE rfFI� . A4,4x S % eoo r 44", <br />MECHANICAL PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture ure <br />List of Fixtures <br />— <br />Fixture <br />CountCount <br />List of Fixtures <br />Fixture <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 />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 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 />Isewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />jNo. of Heads <br />Chemical Suppression System <br />No. of Heads <br />ACKNUWLELJ&f:MLN l: 1 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. 1 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 of Everett Official Use Only <br />PERM <br />(Revised 1011012018) <br />Z <br />