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%;1611 f� PERMIT APPLICATIO <br />BUILDINAMECHANICAL / PLUMBING / SIGNPRINKLER / DEMOLITION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WA S H I N G TO N (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everettensOevprettwn nnv I wueu nvarartuia nnvfnarmifc <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: f ti &,. J 11 _Iflka W41ilPROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: <,",66,11 ^/ It Z- jg7_17 TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY STATE Zip 1 l <br />OWNER PHONE: `' , �, <br />OWNER EMAIL: Ir' 6e"1(_i' / � -/1 J i C C) %7,1 <br />CONTRACTOR NAME: , e tt,, rL .+[ r ; r <br />CONTRACTOR ADDRESS: STREET :5' . C 14' r <br />CITY1-2214114 STATE r Z A ZIP' -- <br />CONTRACTOR PHONE: - - ' ' '%�s <br />CONTRACTOR EMAIL: I. <br />CONTRACTOR LICENSE #(REQUIRED): 'j1 l-,'L c� Z <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): L� <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL:,4j,/,.,,#rC lL �c:� ti t,✓ i Cr: C � ,?i <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ & ` T <br />Proposed Use of Building: <br />Heat Source: ❑Gas E3Electric 00ther <br />BUILDING USE: ❑SFR ❑Townhouse []Duplex ❑ADLI 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: 12e7s70G,.t' C/o/ �'I If e,0I4C r ! tf.� <br />c /dlrrl D /2SW,!7-C-r41 f';V, 145' NC-Cd�d`, <br />ASSOCIATED BUILDING PERMIT # if applicable): I$W X7. lfad r- 4,oeC— Q <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />List of Fixtures <br />Fixture <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 />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 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 />IMedical 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 />jNo. of Heads <br />Chemical Suppression System <br />I No. of Heads <br />Au NOWLEDGEMtN f: f 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 />PERMI^ <br />zed Agent Signature110,ate (Revised 1011012018) <br />Z <br />