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EVERETT <br />PERMIT APPLICATION <br />BUILDINGtECHANICAL / PLUMBING / SIGN /SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />/M A)r-7F7-RR1n 1 FAX 495-957-RR57 I (F) eve retteos(cDeverettwa.gov I www.everettwa.gov/permits <br />WASH INUI UN �• •�----. __._ _. . <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 1 816 Cedar St Everett WA 98201 <br />PROPERTY TAX #: 00531300102402 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Parkview Services TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 17544 Midvale Ave N. Suite LL <br />CITY Shoreline STATE WA Zip 98133 <br />OWNER PHONE: (206) 542-6644 <br />OWNER EMAIL: peter (Lb parkviewservices.org <br />CONTRACTOR NAME: MAD Construction <br />CONTRACTOR ADDRESS: STREET` (©� L cti1f-P• uciGk�t 4 e-- <br />CITY �iCJ(,} <br />STATE (" zip <br />CONTRACTOR PHONE: IS 5X-S <br />CONTRACTOR EMAIL: f'vj cc',. fQ_ `.:C3 F_ c`,w� <br />CONTRACTOR LICENSE #(REQUIRED): Mij()UI <br />ICITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 5 <br />PRIMARY CONTACT: ❑ OWNER El CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Kevin Young <br />CONTACT PHONE: .;253 <br />CONTACT EMAIL: 1 <br />BUILDING INFORMATION <br />Existing Use of Building: Residential <br />Contract Price of Work: $ (JC�f ` ✓ <br />Proposed Use of Building: Residential <br />Heat Source: []Gas ElElectric []Other <br />BUILDING USE: EISFR []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: �n,j�- �/� �' ��/ L% /(-z�� Q OLALA K CJ�v't d d M�' , c j/t <br />°n'-t Sf"• 9 Wlt^C� T� LU • �Z hi-10"S i ri L �%�C% �e C/41'^' tom' <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <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 />1 <br />Shower, Tub, or Combo <br />P <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />1 <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />2 <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />1 <br />Toilet <br />Exhaust Hood (Type 1) <br />lHose 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 />1 <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 />lNo. of Heads <br />ACKNOWLEDGEMENT: 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. 1 am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />anrd I rmmnlv with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Owner/Authorized Agent <br />City of Everett Official Use Only <br />PERMoO&00 W45 <br />(Revised 1011012018) ' ' <br />