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PERMIT APPLICATIO <br />BUILDIN ECHANICAL / PLUMBING / SIGN� <br />tPRINKLER / 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) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: ��- 1 tJ L'-r±iL r[ PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />1 <br />OWNER NAME: ,AZ2" jQl TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY r / .r STATE 7JP <br />OWNER PHONE: r - ' Gr - 6 6® <br />OWNER EMAIL:1•°bG��C <br />CONTRACTOR NAME: i . X, — " C A,/ 14 i4C L <br />CONTRACTOR ADDRESS: STREET 42 VqJ - %LCc, c. 0 if /41,1 C7 <br />CITY CLIr4 STATE ZIP �? <br />CONTRACTOR PHONE: t' - ' <br />CONTRACTOR EMAIL: I / ,? d ii --.--C it , -- <br />CONTRACTOR LICENSE :RE # QUIRED ' <br />( ) J7 1 t'✓G �% L / <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 51 S <br />PRIMARY CONTACT: ❑ OWNER [CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL:f49 j /f.r / e 74 l e-Adi 6,1 z~ i Cc; C C .A? <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $20 <br />Proposed Use of Building: <br />Heat Source: OGas OElectric 0Other <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: 12C016 ,'C' <br />r .r 7� 1 %45' 9--' & it d r l <br />ASSOCIATED BUILDING PERMIT # if applicable): X S% /ZOO )r- Q 12 FA <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 />113as Piping <br />lBackflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />IClothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />IDishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />JDrinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatio <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinalnte <br />Exhaust Hood (Type II) <br />Water Heater <br />Irceptor-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 />INo. of Heads <br />Chemical Suppression System <br />INo. of Heads <br />AGKNUWLElJGEMENT.• 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 WA C. <br />City of Everett Official Use Only <br />G`�� "7 PET Z "� <br />Agent Signature Date (Revised 10/10/2018) <br />