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PERMIT APPLICATIOAk <br />BUILDINOMECHANICAL / PLUMBING / SIG PRINKLER / DEMOLITION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-9F,7-RRF7 I /F1 avc,a++o r% 16.. _--___.1_ _ <br />- - - -- --• ---• -�- �- ...+..aVcvU—L-a.yvv I www.Cveieuwa.govipermits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION - <br />PROJECT SITE ADDRESS: . � 2'67 6 f/e ✓c i% wGL <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />CONTACTINFORMATION: . <br />- <br />OWNER NAME: Cw✓-Co.1 / C <br />1. Gy <br />TENANT BUSINESS NAME (Commercial): Cj - , C alce <br />OWNER MAILING ADDRESS: STREET V-Iti <br />t4/ tr© e dI,- <br />CITY �✓ �tG <br />STATE �L� ZIP CZ <br />OWNER PHONE: T< Z <br />, <br />OWNER EMAIL: lcf v� t !% �,v+ il�uEtC <br />CONTRACTOR NAME: LO Tie <br />CONTRACTOR ADDRESS: STREET p <br />T1i r <br />CITY <br />STATE ZIP <br />CONTRACTOR PHONE: '3 may, — CONTRACTOR EMAIL: ® '-/ Cy <br />CONTRACTOR LICENSE #(REQUIRED): O 10 CT � CITY OF EVERETT BUSINESS LICENSE #(REQU D):� Httf ' 1 � <br />PRIMARY CONTACT: Li'6WNER ❑ CONTRACTOR El OTHER (Please Specify) 11 O k 21 0 <br />CONTACT NAME: <br />CONTACT PHONE: Z�/ `?� L(VO <br />CONTACT EMAIL: <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ C ". r'C'i;! oc <br />Proposed Use of Building: <br />Heat Source: 2(las. ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: Efr6ornmercial ❑Accessory Structure <br />Type of Project: 13New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL 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 />Boiler <br />Clothes Dryer <br />Duct System (Remodel) <br />Exhaust Fans (Residential) <br />Gas Piping <br />Gas Range <br />Heat Pump&Ductless <br />Refrigeration <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Backflow Preventer (Inside Bldg) <br />Clothes Washer <br />Dishwasher <br />Drinking Fountain <br />Floor Drain <br />1 <br />IShower, Tub, or Combo <br />Sink -Commercial (3-comp,prep,floor) <br />Sink -Residential (kitchen, bath, bar) <br />Sink -Utility, laundry, mop <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />Exhaust Hood (Residential) <br />Forced Air Systems <br />Gas Fireplace/Insert/Log <br />Water Heater <br />Wood Stove <br />Other: <br />I <br />Interceptor -Grease <br />Interceptor-Sand/Oil <br />Medical Gas <br />I Roof Drains <br />I <br />lWater <br />lWaste/Water Piping Repair <br />lWater Service (behind meter) <br />Valves or Fixtures <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />Chemical Suppression System <br />No, of Heads <br />No. of Heads. <br />nav& ruv,aweu rms appncanon and connim 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 1 am authorized by the owner of this property to perform the work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Agent Signature Date <br />City of Everett Official Use Only <br />IP T# <br />( -- 02 <br />(Revised 411512019) � F <br />