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EVERETT <br />WASHINGTON <br />PERMIT APPLICATICO <br />BUILDINO MECHANICAL / PLUMBING / SIGN / 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: 5115 r r t <br />PROPERTY TAX #: d 0502. <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Q <br />TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET .0• V % 2-22 O <br />CITY i✓ STATE <br />WA ZIP 6Z0 <br />OWNER PHONE: ? - — <br />OWNER EMAIL: <br />G(7aa y1 <br />CONTRACTOR NAME: WMW <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR N OTHER (Please Specify) / <br />CONTACT NAME: / 1 UUa LP3a Gr- <br />CONTACT PHONE: „ 2 _ 066 <br />CONTACT EMAIL: t-wiles.GD <br />BUILDING INFORMATION <br />Existing Use of Building: 09I.C.0 <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: Gas ❑Electric []Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: &6ommercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair Rl .l. []Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: rOYLI/:t�►� lJ�o t' O T-1 V% �n ltv�ay. w, ou o ►ctS� par' r coh <br />Walk a4 add aco� c. �L�'�li,� 9�'t'ot �- �Po�h, I�„9. WOV-9 h► al.. l�►ct�cie et v►,Gw <br />c 4.1c,114/lee" rrn . Avtot w o OPwrVt%je �DAr� I f i D W A /IS . <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 Ventilation <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) <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 />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />I <br />No. 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 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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PE IT <br />02- 0q5J <br />(Revised 1011012518) <br />