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PERMIT APPLICATION* <br />BUILDING / 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/permlts <br />(Blue or Black Ink, Only Please)) <br />PROJECT SITE: INFORMATION <br />PROJECT SITE ADDRESS: , 3® 7 <br />/- <br />6k) Bee I -erett ROPERTY TAX #: DO�P (2�760Z) <br />LEGAL for new construction: Short Plattsubdivision <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: K/Or an 1 0 P <br />TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET <br />lceL S T <br />CnY <br />1 ^ <br />STATE • i zip / (J 7-0 <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: 71 <br />V- k)e <br />Vtr <br />m4Pon <br />CONTRACTOR ADDRESS: STREET <br />qlr 8� <br />7" <br />CITY <br />��C, <br />�j(, ZIP <br />CONTRACTOR PHONE: <br />2-5 '7 7 <br />' L,S,TA,TE <br />n,. <br />CONTRACTOR EMAIL: RA-/L (2 Kd I Ao L m.m <br />,, tt <br />CONTRACTOR LICENSE #(REQU ED): Q ZOOS _l LA C OF EVERETT BUSINESS LICENSE #(REQUI ED): SS( ZSO <br />PRIMARY CONTACT: ❑ OWNER <br />RACTOR OT Rilease Specify) <br />CONTACT NAME: <br />m �li I A ��y��>' ('s <br />A T PHONE: AtS 77 , j 6639 <br />CONTACT EMAIL: ��72C1 Ao L ^ (fa---L <br />BUILDING INFORMATION <br />Existing Use of Building: RE5 4r\ e—'Q — <br />Contract Price of Work: $ v <br />Proposed Use of Building: <br />I <br />Heat Source: []Gas Electric ❑Other <br />BUILDING USE: 1XSFR []Townhouse ❑Duplex ❑ADU []Multi -Family - # Units: ❑Commercial []Accessory Structure <br />Type of Project: ❑New (Addition ❑Remodel ❑Repair <br />❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF 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 />/ <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 PumpBDuctiess <br />Dishwasher <br />Sink -Residential (kitchen,bath,bar) <br />Duct System (Remodel) <br />Refrigeration <br />I 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 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 />INo. 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 MIT#c(o(4 <br />Authoriz A Signature Date (Revised 1011012018) <br />