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0 PERMIT APPLICATION • <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />4m7r 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: J q (l Oce-�,t f x 6✓trees 2d_? <br />PROPERTY TAX #: d 0 `9 6 % 00 �—b I ! 0 <br />LEGAL for new construction: Short PlaUsubdivision ] 01 L1 Pyr <br />1s LK 09 j Lot No._IA_ (attach copy of long legal description) ! fie, j- i <br />CONTACT INFORMATION <br />OWNER NAME: CKI It,, y(tndeLr Vu, <br />TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET <br />Am <br />11 CITY �V <br />STATE "V�/ <br />ZIP 98 2�3 <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: <br />a <br />CONTRACTOR ADDRESS: STREET <br />CITY - "'—'"1'--r--Ht <br />STATE <br />ZIP <br />CONTRACTOR PHONE: CZ06) <br />CONTRACTOR EMAIL: CaIV � V V <br />(p"Yj <br />CONTRACTOR LICENSE #(REQUIRED): <br />I CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: % OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: C4,I V U',"c�Cr A"" <br />CONTACT PHONE: ('Zp((?� <br />CONTACT EMAIL: CcI VV C a <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ v V <br />Proposed Use of Building:%� cr.-,rl <br />Heat Source: ❑Gas ❑Electric ❑Other <br />BUILDING USE: 0SFR ❑Townhouse ❑Dupl x ❑ADU ❑Multi -Family -# Units: ❑Commercial * ❑Accessory Structure <br />Type of Project: ❑New Addition ❑Remodel ❑Repair <br />❑T.I. ❑Sign ❑Sprinkler ❑Demolition <br />❑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 II) <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 />I <br />Forced Air Systems <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 <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 befo being authoriz d 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 I co I with t State Contra rs Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />�-1117 _ 1 Z ^ ! J PERMI < oC5 <br />O� <br />Owner/A,thonzed Agent Signature Date (Revised 1011012018) <br />