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I� PERMIT APPLICATIQU <br />BUILDS MECHANICAL / PLUMBING / SIG 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: GtY t yn er F-d. Ev 2rc,i-I- W <br />PROPERTY TAX #: Z $O S 0 8' 0o'1 0 13 DO <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: mares G10I i v—P, TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET �- i ff Lar-'i OI. <br />,• ' ^ <br />CITY STATE ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: OWKtr <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: <br />ML-Arlc. GIOh -,c <br />CONTACT PHONE: L4 Z S — 91 1-11 — 9 9 S (Y- <br />CONTACT EMAIL: YY)D�rk-. ' of kk_c (pq ma, 1 • C,om <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ AW <br />Proposed Use of Building: <br />Heat Source: ❑Gas gElectric ❑Other <br />BUILDING USE: ❑SFR []Townhouse ❑Duplex IdADU ❑Multi -Family -# Units: ❑Commercial ❑AccessoFy-Strucfure <br />Type of Project: X New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign []Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: <br />W e, arc bvti lOUV-9 a 4q �- sao. F4. ADUt -tb duser CGre. Off- m� fa+her as a res�-� �-�- <br />0� his rcce-n - s+rbkc. <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 />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />1 <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Z <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 />I <br />Toilet <br />Exhaust Hood (Type I) <br />I <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />lWater Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />lWood 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 />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 />No. of Heads <br />Chemical Suppression System <br />No. of Heads <br />ACKNOWLEDGEMENT. l 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 / am authorized by the owner of this property to perform the work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PER fjlu <br />(Revised 411512019) <br />