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EVERETT <br />WASHINGTON <br />PERMIT APPLICAT 4 <br />NU BUILDI/ MECHANICAL / PLUMBING / S1 / SPRINKLER / DEMOLITION <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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 'SFPROPERTY <br />TAX #: <br />LEGAL for new construction: Short Plattsubdivision <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: &'7 <br />TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY <br />STATE <br />ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: <br />? <br />CONTRACTOR ADDRESS: STREET <br />CITY <br />Q <br />STATE tJ S <br />ZIP <br />CONTRACTOR PHONE: Lkt — *3Z? C'3 C fr $ <br />CONTRACTOR EMAIL: "(3k—OLj <br />tp c4 <br />`,J <br />CONTRACTOR LICENSE #(REQUIRED):(] 1 CITY OF EVERETT BUSINESS LICENSE #(R(QUIRED): T t S <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Ct—e<\ <br />CONTACT PHONE: <br />CONTACT EMAIL: 0 J2 -� C ("X CJVkX <br />BUILDING INFORMATION <br />Existing Use of Building: ,j`<� <br />Contract Price of Work: $ v 5== <br />Proposed Use of Building: <br />Heat Source: as Electric <br />Other <br />BUILDING USE: ❑SFR ❑Townhouse El Duplex ❑ADU ❑Multi -Family - # Units: mercial <br />❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair <br />❑T.I. ❑Sign []Sprinkler ❑Demolition <br />❑Change of Use <br />DESCRIPTION OFI WORK: <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 <br />Hose Bibb <br />Urinal <br />x aust Hood (Type ll) <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 />I <br />10ther: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER <br />/ 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 confirml1beinformation 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 1 am authorized by the owner of this property to perform the work for which application is made, <br />and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />2�0 -v'S <br />Date (Revised 411512019) �/J <br />