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0 PERMIT APPLICATION • <br />BUILDING /MECHANICAL /PLUMBING /SIGN /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 />// <br />PROJECT SITE ADDRESS:, tJ� r /�' !? IOC 'C .� PROPERTY TAX #: C>�i�, 7(J, GI),Z "IrC) <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />9 <br />OWNER NAME: —� _ LL/✓ t TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY ee�5_Ve�,e&717 STATE <br />OWNER PHONE: �' �� -cT 7 4/ <br />�ZJIP <br />OWNER EMAIL: �(J'yf / /�/��iU, <br />CONTRACTOR NAME: <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: 10OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME. <br />014 <br />CONTACT PHONE: <br />CONTACT EMAIL:D�75 <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: 6L4 C i4l <br />Heat Source: []Gas ❑EI Ic ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse uplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: , _New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Ch nge of Use <br />DESCRIPTION OF WORK:. / C I 41�­ / 0� � �i &'Ll i � � <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 Fix es <br />A/C — Air Handling Units <br />Gas Pip' <br />Backflow Preventer (Inside Bldg) <br />Shower, T , or Combo <br />Boiler <br />Ga ange <br />Clothes Washer <br />Sin ommercial (3-comp,prep,floor) <br />Clothes Dryer <br />laeat Pump&Ductless <br />Dishwasher <br />ink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilation <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Typ t) <br />Water Heater <br />Interceptor-Greaw," <br />Waste/Water Piping Repair <br />Exhaust Hood sidential) <br />Wood Stove <br />Interceptor--146d/Oil <br />Water Service (behind meter) <br />Forced Air stems <br />Other: <br />Medottas <br />Water Valves or Fixtures <br />Gas Fir ace/Insert/Log <br />f 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 b fore being authorized under any circumstance. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply wi t4p State Contractors Law 1$.?7 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMI� I � � — bl�_^ <br />Date (Revised 1011012018) EJV1 —� <br />�, '/z <br />