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i� <br />EVERETT <br />WASHINGTON <br />PERMIT APPLICATIO[q <br />BUILDING' / PLUMBING / SIGN I PRINKLER / 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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 5 5- Lp ✓e- 6 -etr IB Z 113 <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: xm kfvSZ TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET S S 5yI ocew, Ave, <br />q 9 7 <br />CITY �/vtrt J 7 STATE V 1 J/� ZIP <br />OWNER PHONE: �'' `' '/ <br />OWNER EMAIL: <br />CONTRACTOR NAME: V6"Jer vae" CQ1%j4(vc;7'D-. <br />CONTRACTOR ADDRESS: STREET g D .S �j'ldir� l o S at a l�l " LI <br />CITY �V erf— 1 STATE w' ZIP <br />CONTRACTOR EMAIL: C41r%VEk&; o�CONTRACTOR PHONE: (ZoO iy?-D/ <br />CONTRACTOR LICENSE #(REQUIRED): VA N p E U C ICITY OF EVERETT BUSINESS LICENSE #(REQUI EI <br />PRIMARY CONTACT: ❑ OWNER i� CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: C700 6 y- l D I <br />CONTACT EMAIL: eil (v ^ V Y e <br />BUILDING INFORMATION <br />Existing Use of Building: �� �L.f-'� / <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: [etas ❑Electric ❑Other <br />BUILDING USE: i5iSFR ❑Townhouse []Duplex ❑ADU El Multi -Family -# Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New aAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: Aga Se L ^d �' AL, vc e iJ�r ^y y A'o (,(J 1��f /v <br />4:::AN7­/t_EviC� Dec AIV0 S2-,41AS 70 �,� CwoL)Aiv L&'6L <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 />nt <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-comp,prep,floor) <br />Clothes Dryer <br />Heat..Pump&Ductless <br />Dishwasher <br />Sink-Residegtidl(kitchen,bath, bar) <br />Duct System (Remodel) <br />afrigeration <br />Drinking Fountain <br />jSin k-.(ltittfy, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />11 <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type jiy <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 Stems <br />I <br />10ther <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fikeplace/InserULog <br />Roof Draios'' <br />Water Heater <br />SP KLER / SUPPRESSION <br />SYSTEM <br />§oylfage Ejector or Sump Pump <br />Other: <br />Water S pression System <br />lChemleal <br />7No. <br />of Heads <br />Suppression System <br />I 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 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 />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PE #� O — 0 rLj <br />(Revised 411512019) <br />