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PERMIT APPLICATION <br />BUILDING/ MECHANICAL1 PLUMBING 151GN /SPRINKLER /DEMOLITION <br />EVERETT 32CITY OF EVERETT PERMIT SERVICES <br />00 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 Pleas®) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: a d' <br />PROPERTY TAX # <br />LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME:'` lFt ( ° ' TENANT BUSINESS NAME (Commercial): r ... <br />OWNER MAILING ADDRESS: STREET <br />CITY ;✓ '.....-'" STATE ; i'.. ZIP <br />OWNER PHONE: sp y?.. OWNER EMAIL: r :: � ' ;' <r. , l ° - a 1 `34 F, 1 <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET f,' ' All . t <br />CITY < '"�,r °l ..... �'•..' 9 STATE lip <br />CONTRACTOR PHONE: { ; `} I? ] <br />CONTRACTOR EMAIL: :) .R - „��, —� <br />7 <br />CONTRACTOR LICENSE #(REQUIRED): 1c f ' r'_-, <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED):f <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR © OTHER (Please Specify) <br />CONTACT NAME: <br />t <br />CONTACT PHONE:, <br />CONTACT EMAIL. <br />BUILDING INFORMATION <br />Existing Use of Building: �) � ;.r,,,� ,•�.���. � r, r���>,,v% <br />d <br />Contract Price of Work: $ = ' <br />Proposed Use of Building: <br />Heat Source: []Gas ❑Electric ❑Other 941 <br />BUILDING USE: CISFR ❑Townhouse []Duplex DADU ❑Multi -Family- # Units: wCommercial OAccessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Re air QT.I.... OSi n ...D.S rinkler MDemolitlon .....00han e of Use <br />DESCRIPTION OFgWORK: , 4"_ �* �-t�"'ItpC�`/.gam �dI, ' ;j-r'�`.L/ - <br />t�"�.+f+♦rs''�`?"C-ir'�'`C.'`.P �'y'�1�j•"f{� `M'a..: <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANICAL <br />PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />FixtureFixture <br />Count <br />Count <br />List of Fixtures <br />Court <br />Count <br />List of Fixtures <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-oomp,prep,floor) <br />Clothes Dryer <br />Heat Pum &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 Ventiatior <br />(Not Heat/AC system) <br />Floor Drain <br />IToilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <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 Fireplacellnsert/Log <br />I <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 No. of Heads <br />Chemical Suppression System <br />jNo, 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 / am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />' PER75�'DO( <br />�, G%\I <br />F r <br />Owner/Authorized gent Signature� Date (Revised 1011012018) <br />