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PERMIT APPLICATION <br />BUILDINAECHANICAL / PLUMBING / SIGN W—RINKLER / DEMOLITION <br />EVERETT 32CITY OF EVERETT PERMIT SERVICES <br />00 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P)425-257-8810 1 FAX425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: ) LI CT C ;i✓p - G <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: C j ��{, TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 14 S A S G ,j141 3I G <br />CITY �� STATE I,i..iA ZIP <br />OWNER PHONE: OWNER EMAIL: <br />ti. <br />a no <br />CONTRACTOR NAME: na� v j G 0 1 l 3- ov 1 <br />CONTRACTOR ADDRESS: STREET _0 44 t 3 <br />CITY T (±N VLY STATE ✓" ZIP Z- 9 2— <br />CONTRACTOR PHONE: 32 % - 2 c—, ­/ <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): L V (� lT <br />CITY OF EVERETT BUSINESS LICENSE #(REQUI ): <br />PRIMARY CONTACT: ❑ OWNER DdCONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: L4 Z S - 32 ? - L o -1 <br />CONTACT EMAIL: p,. ozli Pr o <br />BUILDING INFORMATION <br />Existing Use of Building: Lewk,InA <br />Contract Price of Work: $ 001 00 <br />Proposed Use of Building: 14- A-.e- <br />Heat Source: []Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU []Multi -Family - # Units: WCommercial []Accessory Structure <br />Type of Project: ❑New ❑Addition emodel ❑Repair ❑T.I. ❑Sign []Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: i <br />� M a � � �-,3-ti�,� tGt ��� s ,t .� l� , /✓I G � fix, �a, � N� y- ►�.1��- <br />� I�) 44 Some 4� (4,t_ <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 ge <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />t Pump&Ductless <br />Dishwasher <br />o� <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 vennatior <br />(Not Heat/AC system) <br />loor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Typ ) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood sidential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air stems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fir ace/Insert/Log <br />Roof Drains <br />lWater Heater <br />SP KLER I SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: H I, is Oro �h <br />Water 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 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 l comolv.gth the State Contractors Law 18.27 RCW and 296.200A WAC. <br />to <br />Owner/Authorized Agent Signature <br />City of Everett Official Use Only <br />s3 ►� P ��k0- �o`Z <br />Date (Revised 411512019) <br />