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®® PERMIT APPLICAT <br />BUILDIN / MECHANICAL 1 PLUMBING / SIG SPRINKLER / DEMOLITION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.evereth%la.gov/permits <br />1-5— V[ blaCk Ink 0my mease) PROJECT SIT E,11►IFQRMATI®N <br />PROJECT SITE ADDRESS: 020 C : Pi ery Q PIC111wev Jf4CO LL , <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: Rot 2 Alaettl.S L TENANT BUSINESS NAME (Commercial} <br />OWNER MAILING ADDRESS: STREET620 St E mall Ohlu- 146c) <br />c,TY EVe. Gtt STATE LL/4 ZIP C <br />OWNER PHONE: 41 - rJ q5' 5150 OWNER EMAIL: rC rt . GIq cj 5/ ?% ` C4hC'(J . Ct7-I <br />CONTRACTOR NAME: i U 'V <br />CONTRACTOR ADDRESS: STREET jCj2_ r% <br />+/ ^ (f <br />Cry EVl� STATE w ZIP el <br />CONTRACTOR PHONE: , tj <j - 6,543 <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): (_ E F9, L <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER IK ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: 4 2,' 355 . 6-c5 q ,3 <br />1- <br />a U l ► /Ci �C CONTACT EMAIL: ►l CSC �h . <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ �? <br />Proposed Use of Building: <br />Heat Source: []Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex OADU ❑Multi -Family -# Units: [commercial DAccessory Structure <br />Type of Project: ❑New OAddition ❑Remodel ❑Repair ❑T.I. []Sign @Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />In s7/0c hco oC nec v UL 36v Fire �e sSiol Sys'ky n . <br />.Znclodes f-efn,,1aL afxL'tfs �t of exiskn� �/,-e <br />ASSOCIATED BUILDING PERMIT # (if applicable): r --CCJ. <br />MECHANICAL PERMIT <br />APPLICATION <br />PLUMBING PERMIT 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 />Fi <br />Fixture <br />t <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 />Clothes Dryer <br />Gas Range <br />Heat Pump&Ductless <br />Clothes Washer <br />Dishwasher <br />Sink -Commercial (3-comp, prep, floor) <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 Ventilatio <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type I) <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 />lWater <br />Service (behind meter) <br />Forced Air Systems <br />Gas Fireplace/insert/Log <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Roof Drains <br />Water Heater <br />SPRINKLER I SUPPRYMAIION <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 />.,­vvvv,L=ijGcuvuruv r: i have reviewea4bie-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 circumsta ce. 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 with the State Contractors Lava 18.27 RCW an46.200A WAC. <br />City of Everett Official Use Only <br />PER T <br />(Revised 4/15/2019) <br />