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0 PERMIT APPLICATION* <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />EVERETT 32CITY OF EVERETT PERMIT SERVICES <br />00 CEDAR STREET, EVERETT, WA 98201 <br />fp) 429-257-8810 l FAX 425-257-8857 1 (E) everetteps@everettwa.gov j www.everetbNa.gov/permits <br />vvnan nv �a i v,v �• i -- -- -- - - - <br />(Blue or Black Ink Only/ Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 52- rrojl <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: D 2� Y- 6Yl TENANT BUSINESS NAME (Commercial): <br />— <br />OWNER MAILING ADDRESS: STREET Y— IAAI'— <br />CITY Q/�C. STATE 7JP 4/ V <br />OWNER PHONE: LM5 O -j 9 <br />1OWNER EMAIL: <br />CONTRACTOR NAME: L <br />CONTRACTOR ADDRESS: STREET V ZD� 134c'1 C i� <br />CITY ��'� �l L. STATE Ll-.Y +- l ZIP <br />CONTRACTOR PHONE: 'Z') 2.5Z - 3 / ( <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): t�-V <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED). 00 -7 9 <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: 1 <br />She- <br />CONTACT PHONE: (4 z5) 0-�_ 0 7Z"3, <br />CONTACT EMAIL: ari_$5+,�t <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: as ❑Electric ❑Other <br />BUILDING USE: WFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repairf.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: (t <br />,�q-to <br />ASSOCIATED BUILDING PERMIT # if ap licabie}: <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Fixture Fixture Fixture <br />Count List of Fixtures count Fixture List of Fixtures Count List of Fixtures Count List of Fixtures <br />A/C — Air Handling Units <br />Boiler <br />Gas Piping <br />Gas Range <br />Bacicflow Preventer (inside Bldg) <br />Clothes Washer <br />Shower, Tub, or Combo <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 (Tye 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 />11A.M <br />Roof Drains <br />Water Heater <br />SPRINKLER I 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 Offlclal 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />vJ � „? PERMI �-2-= <br />l O <br />O ner/Authorized Agent Signature ate (N (Revised 10/ 012018) fll, <br />