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PERMIT APPLICATIO <br />BUILDING 1 MECHANICAL /PLUMBING / SIGXPRINKLER / 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 />(slue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: X 1 & jr <br />PROPERTY TAX #: 0_"7 10 ip <br />LEGAL for new construction: Short Plat/subdivision 15 ti;ll p-f&jk,, Lot No 1'Z-;;�attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: _5ZV ft0T' C TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET Z3i$ <br />CITY 114F"ramr STATE LLAC ZIP "ZO/ <br />OWNER PHONE: - ZQ/— — <br />OWNER EMAIL: �(_J _ C' <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 fXOTHER (Please Specify) <br />CONTACT NAME: '01S4 ff2SiVAf <br />CONTACT PHONE: 340'S7Z <br />CONTACT EMAIL: e YjLA&-) - 'r'C'1x <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: 64X44grarx <br />Heat Source: ❑Gas ❑Electric ❑Other Al O <br />BUILDING USE: 4 13FR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # 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 />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 />Frxwre <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 Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />lRefrigeration <br />jDrinking 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 11) <br />Water Heater <br />Interceptor -Grease <br />Waste/VVater Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />I <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 I <br />No. of Heads <br />Chemical Suppression System <br />I <br />jNo. of Heads <br />ACKNOWLEDGEMENT; ! 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. 1 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 />PERMIT # <br />