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0 <br />EVERETT <br />WASHINGTON <br />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/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: / 5 ( <br />PROPERTY TAX #: Cc �t Vccej,G <br />LEGAL for new construction: Short Plat1subdivision Lot No. (attach copy of long legal description) <br />C NTACT INFORMATION <br />OWNER NAME: (�,l ' ! ` — r ' L/i 1,1k TENANT BUSINESS NAME (Commercial): <br />-�- <br />OWNER MAILING ADDRESS: STREET lee/ <br />CITY ­ STATE 1 BP 2v <br />OWNER PHONE: /_*27T_ 67 32- TL <br />1OWNER EMAIL: <br />CONTRACTOR NAME: - .__ ' '�� <br />CONTRACTOR ADDRESS: STREET r17 ,r'r-- " <br />/ <br />CITY {_.. (�'1i STATE ZIP <br />CONTRACTOR PHONE: 3�, Z, <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE : # REQUIRED r ( ) �. !, <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER NTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: I r <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ ) , T <br />!/� <br />Proposed Use of Build' j { <br />Heat Source: Eldas ❑Electric []Other <br />BUILDING USE: FR ❑Townhouse Ebtwlex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition 'model ❑Repair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition ❑Chan a of Use <br />DESCRIPTION OF WORK: r �G�f i c3\J t,.L_.aF r-Z- t{ ���L 1 l J15— livbo -r <br />L6'I C �'j <br />-c� <br />FD ol°u' w Ld +-L- c-- <br />ASSOCIATED BUILDING PERMIT # (if applicable): ^ t= c I /�L�2 /� <br />MECHANICAL PERMIT 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 />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 PumpBDuctless <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 (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />lWater Heater <br />Interceptor -Grease <br />WasteiWater 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/ InserULog <br />Roof Drains <br />I <br />lWater Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />IIISewage Ejector or Sump Pump <br />other: <br />Water Suppression System <br />I <br />INo. of Heads <br />Chemical Suppression System <br />I <br />I No. of Heads <br />ACKNOWLEDGEMENT 1 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 />-S /! ,G <br />own' Authorize gnat ate <br />City of Everett Official Use Only <br />PER oO5 "-00 <br />(Revise 10/1012018) <br />K2z — <br />Yv <br />