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• PERMIT APPLICATION 0 <br />BUILDING /MECHANICAL /PLUMBING /SIGN /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 Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 21 I A t_ve iZ So.,j <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: 'V1 6 u AR _D jL. C bP_ TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 2 1l'l n L_i��s C,J 1��^ <br />p i <br />CITY E—VG ?f- <gLCJ TT STATE 1,/V 1—t ZIP q 1 <br />OWNER PHONE: 42 `S -S 5 C S-A -I <br />OWNER EMAIL: rSLCc� r' �L l ;vi tt �i .AGM <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: %OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: RIG i-IA >Z1� SL LLB I <br />CONTACT PHONE: 416 • 3 J 0 - 54-7 <br />CONTACT EMAIL: r �C C r 2 C I 1 L< <br />BUILDING INFORMATION <br />Existing Use of Building: <br />lContract Price of Work: $ cam' <br />Proposed Use of Building: <br />I Heat Source: jr.Gas ❑Electric ❑Other <br />BUILDING USE: ❑IS,'FR ❑Townhouse ❑Duplex *DU ❑Multi-Famil - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: &ew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />QE"cVAL cp r.:XVS Im§ 6)AP_AqE: A^Jb oi= DA ►Dit. <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 I <br />List of Fixtures <br />Fixture <br />Count <br />r�L st of Fixtures <br />A/C — Air Handling Units <br />Gas Piping­-Backflow <br />Preventer (Inside Bldg) <br />Z <br />wer, Tub, or Combo <br />Boiler <br />a !!Range <br />1 <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />t <br />Clothes Dryer <br />eat Pump&Ductless <br />t <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />I <br />Sink -Utility, laundry, mop <br />Z <br />Exhaust Fans (Reside I <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood ITyp <br />Hose Bibb <br />Urinal <br />Exhaust Hood,(pe II) <br />Water Heater <br />Interceptor-Gr <br />Waste/Water Piping Repair <br />t <br />Exhaust od (Residential) <br />Wood Stove <br />Interceptor-S d/Oil <br />Water Service (behind meter) <br />Forc Air Systems <br />Other: <br />Medical as <br />Water Valves or Fixtures <br />as Fireplace/Insert/Log <br />Ro9P6rains <br />Water Heater <br />PRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Wafer 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 Official beforAeing 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 l comply with th6l Stpte Contractors Law 18.27 RCW and 296.200A WAC. <br />Agent Signature <br />City of Everett Official Use Only <br />PERMIT �'D <br />(Revised 10/10/2018) <br />�i <br />