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• PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / S NKLER / 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 />INFORMATION <br />(Blue or Black Ink Only Please))PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: I "I D- I � DA �_a, C'`,�a <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: �t(� K—%� TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: \ STREET <br />CITY (,. �J STATE ZIP <br />OWNER PHONE: G) <br />OWNER EMAIL: <br />CONTRACTOR NAME: Cam' YY\k eLyy1 <br />bli UYL j <br />CONTRACTOR ADDRESS: STREET I & C <br />` <br />CITY � '(r V L, STATE ��j/l'�� ZIP <br />CONTRACTOR PHONE: ' �� -, �—� <br />I <br />CONTR�A]C,TOR EMAIL: i Y\" 7 �L <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER �] CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />l JQ i'f. 6&lrl(�Gl�il <br />CONTACT PHONE: '� C <br />CONTACT EMAIL: i <br />C,_0� <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: ❑Gas WElectric ❑Other <br />BUILDING USE: MSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair LIT. 1. ❑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 />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 />Clothes Dryer <br />Heat Pump&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 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/Water 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 />lWater Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />I <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 <br />I No. of Heads <br />Chemical Suppression System <br />I <br />INC. 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 I am authorized by the owner of this property to perform the work for which application is made, <br />Wcompithth teContractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />j PER T # <br />t02i 1`'1 �����'�� <br />(Revised 1011012018) <br />