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EVERETT <br />WASHINGTON <br />P VIM T APPLICATION* <br />BUILDING / VWECHANICAL / PLUMBING / SIGN / SPRINKLER / DIE-M LITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />INFORMATION - <br />(Blue or Black Ink Only Please) PPRRO�-�/ <br />MJEECTSITE <br />PROJECT SITE ADDRESS: (z� SE LF�(/GR-E-�AU- ���� 1/ <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:?Ay&L 45�FT I TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET/0'20 -4057— X44A <br />(� <br />}A Q <br />CITY E/'G.t/, • STATE 16j A <br />OWNER PHONE: SQ`J D ! SRO <br />OWNER EMAIL: <br />CONTRACTOR NAME: �" l PfT �GL I�%�JT �� d 04';T-k&� eLk jj aC <br />CONTRACTOR ADDRESS: STREET �j' � ��t�F3� <br />CITY - STATE ZIP <br />CONTRACTOR PHONE: G�2.0 <br />,[, <br />Ili (/ <br />Q �8,L/-I4�( <br />1 C�(ONTRRACTOR EMAIL: T/&113 F(e)IT G(-i.6 6? 64` 441. <br />n�`S /��t,�.. <br />CONTRACTOR LICENSE #(REQUIRED): (2bYC.�-�-1 <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR XOTHER (Please Specify) a4" <br />CONTACT NAME: j� <br />CONTACT PHONE: LfC ZS 3a <br />CONTACT EMAIL: DPp„Li-vt <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />c7, <br />Proposed Use of Building: ��1i / `��� <br />Heat Source: ❑Gas CElectric ❑Other <br />BUILDING USE: ❑SFR ❑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: Ir�,?6441C> tq TE4 �S <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 />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 />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)l <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 />I <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />No. 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. 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 witLolthe State Cc_a recf4Cs Law 18.27 RCW and 296.200A WAC. <br />r/Authorized Agent Sign <br />City of Everett Official Use Only <br />PERMIT # y 10 <br />(Revised 411512019) ! / <br />