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PERMIT APPLICATIO <br />BUILDIN� ECHANICAL / PLUMBING / SIGN�PRINKLER / DEMOLITION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 ( (E) everetteps@everettwa.gov I www everettwa gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS�J v ,j PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: 1 C ' �,-Z- TENANT BUSINESS NAME (Commercial):Cxe rr/t/5• // &GLl &7— <br />OWNER MAILING ADDRESS: STREET <br />CITY fI T STATE �,�%� ZIP <br />OWNER PHONE: <br />OWNER EMAIL: //f e!�� t %Z'� CGpy/ <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />CITY 14114 ..-- STATE ZIPL [? •— <br />CONTRACTOR PHONE: .76 <br />CONTRACTOR EMAIL: y:/ frr �t <br />CONTRACTOR LICENSE #(REQUIRED): }711'/L <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): (j ' <br />PRIMARY CONTACT: ❑ OWNER (CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: L t <br />CONTACT EMAIL.-,,, art' 1Gi4 A�, 6✓ r CCU C c .�j <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Heat Source: ❑Gas OElectric DOther <br />Proposed Use of Building: <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK:L✓�-/f?®i�"�" <br />13 �`/d�Nyt G 12c!p$c -e 5He'r 7-1111tV q57 /L/e�✓ e(,7 <br />ASSOCIATED BUILDING PERMIT # if applicable): 6R"t- 62 86rrex , 1*4X S "% ,gmf Ad fit", <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />List of Fixtures <br />ixtur. <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 />I <br />Gas Piping <br />I Backflow 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 />Drinking 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 />Urinal <br />Exhaust Hood (Type II) <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 />Water Suppression System <br />INo. of Heads <br />Chemical Suppression System <br />No. of Heads <br />ACKNOwLEUGEMENT.• 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 WAC. <br />City of Everett Official Use Only <br />PERMrk;? ^ <br />(Revised 1011012018) <br />1/Z <br />