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PERMIT APPLICATION <br />BUILDING /MECHANICAL /PLUMBING /SIGN /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.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 5`gl57 C7 UCV.N VU EV ev eTT W PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: C ocil&4a I Cp m A, u i I- ii K, TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET t O 5 2.0 V C- 5 2 <br />, e ` �{ <br />CITY r 1 e"+ f ' STATE W A ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />++'' <br />CONTRACTOR NAME: &'\c F� j+' <br />CONTRACTOR ADDRESS: STREET "Z ( 2 c'U l+'f�t rU G <br />ja <br />a / 'J <br />CITY Woo © 8IIi ' d STATE �. zip 6g& ( K <br />CONTRACTOR PHONE: - -22S — 503 <br />CONTRACTOR EMAIL: Q A)G N j , e� <br />CONTRACTOR LICENSE #(REQUIRED): 14 e A.l e APL ` G & 2 %Z <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): GtOI <br />PRIMARY CONTACT: ❑ OWNER @CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: 3 (90 -- —? CC ^ d 2 G(a <br />CONTACT EMAIL: [ A) A)tf <br />" BUILDING INFORMATION <br />Existing Use of Building: �Ja�ik <br />Contract Price of Work: $ S r�OO <br />n��c <br />Proposed Use of Building: 5"A I� O-W- Ce <br />Heat Source: ❑Gas ❑Electric []Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: XCommercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition KRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: p iu VMS i J 2 2G.5- V-0CA, S <br />ASSOCIATED BUILDING PERMIT # (if applicable): 17 ZOO 2 oO 6 <br />MECHANICAL PERMIT <br />APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Court <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 />`Z <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) <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 />lWater Heater <br />SPRINKLER <br />:1 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, sta nd / cal 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 Offici fore b g 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 com with the ate Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT# �JV? <br />2020 <br />O net uthorized Agent Signature Date (Revised 10/10/2018) <br />