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PERMIT APPLICATIO <br />BUILDINIMP MECHANICAL / PLUMBING / SIGPRINKLER / DEMOLITION <br />OF EVERETT PERMIT SERVICES <br />EVERETT <br />32CITY <br />00 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON <br />(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: M e C e(Jta ( 5 t <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: h ,&L Het r -12�(V1 S TENANT BUSINESS NAME (Commercial): <br />/ <br />OWNER MAILING ADDRESS: STREET L�3 Z CcC�CIY Sf <br />ZIP 2n� <br />CITY ,�,�9,v STATE � <br />` <br />OWNER PHONE: Z�� �(� - 41 <br />// <br />OWNER EMAIL: 6-(5a - - .mi IICY &-cO 6a f- /1,e <br />CONTRACTOR NAME: 5 jffi LP 1Z00- A) <br />CONTRACTOR ADDRESS: STREET 2 03I r 3 No ft E NC, <br />CITY Wl e* I r • L (- F STATE L-0 0 ZIP q o-z— <br />CONTRACTO=PHONE- �C�, } <br />CONTRACTOR EMAIL: RI Fo es(, -v co/it <br />CONTRACTOR LICENSE #(REQUIRED): 6? 911?f, 6fi JZ <br />I CITY OF EVERETT BUSINESS LICENSE #(REQUIRED)5q� <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: ✓� <br />5 w f COOF rC C 6f IGV'�� <br />CONTACT PHONE(H Z� <br />CONTACT EMAIL: by C Au J�� jhu (02. (-V4i1 <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ 17 7 C <br />Proposed Use of Building: <br />Heat Source: OGas OElectric OOther <br />BUILDING USE: XSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign LJSprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: de ave t 0 CJ+"rat t 5lz i r��(c� S GIV ✓ t-y /u G6 e (-JLh <br />C'CJM�dSi7j0&) :,ket *klef / wl' plea Gt 6ivMt"t /CY -0 hr' Olc/�/p� G• l C�'C�C�Y $%��'t''� / /! <br />�2odi�0� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />F Hure <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 />f <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/Inert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER I SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other. <br />Water Suppression System <br />I <br />jNo. of Heads <br />Chemical Suppression System <br />I <br />jNo. 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 *at 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 beirf 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 1 comply with the Statelrontractors Law 18.27 RCW and 296.200A WAC. <br />Date <br />City of Everett Official Use Only <br />PERMI r) <br />�-b <br />(Revised 1011012018) <br />