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� PERMIT APPLICATION <br />BUILDINGQVIECHANICAL / 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 />PROJECT SITE ADDRESS: 1116 <br />��� LAce ! ;w , Pykt�F_0203 <br />PROPERTY TAX #: OD 361— DOD "0-r000 <br />LEGAL for new construction: Short Plat/subdivision M WTI i L• 64Z� t;OW Lot No..0 (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: 9dl°'ik L_uxwAmo TENANT BUSINESS NAME (Commercial): NIA <br />OWNER MAILING ADDRESS: STREET �- I Ct !gi-j <br />CITY ice " I STATE WA ZIP jbzc. � <br />�L <br />OWNER PHONE: (—rZr� 3 24 _ 4 + 0 1 <br />1OWNEREMAIL: <br />CONTRACTOR NAME: ®Nti{- <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: CROWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />to r-A W&MHA <br />CONTACT PHONE: ( It _ c� �p <br />CONTACT EMAIL:BUILDING <br />INFORMATION INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ 3 <br />Proposed Use of Building: '-F-'$iOFWT;A-L' <br />Heat Source: []Gas 399lectric I]Other <br />BUILDING USE: *FR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Comm ial ❑Acce tructure <br />Type of Project: ❑New ❑Addition XRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: 60M UF r i� �F r3� � E � •L D 5� <br />c <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 />Lis fixtures <br />Fi a <br />Cou <br />List of Fixtures <br />Fixture <br />Count <br />Li txtures <br />A/C —Air Handling Units <br />pesPiping <br />flow Preventer (Inside Bldg) <br />j <br />Sh , ub, or Combo <br />oiler <br />Gas Range <br />Cloth asher <br />Ink -Commercial (3-comp,prep,floor) <br />C AiLs Dryer <br />Heat Pump&Ductless <br />Dishwashe <br />Sink -Residential (kitchen, bath, bar) <br />Duct em (Remodel <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />j <br />Exhaust (Re tial) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood a 1) <br />Hose Bibb <br />Urinal <br />Exhaust d (Type <br />Water Heater <br />Interceptor- a <br />Waste/Water Piping Repair <br />Exh ood (Residentia <br />Wood Stove <br />Interce - and/Oil <br />ter Service (behind meter) <br />ed Air Systems <br />er: <br />al Gas <br />Wa Ives or Fixtures <br />Gas Fireplace/Insert/Log <br />oof Drains <br />Water He <br />_7091SPRINKLER / SUPPRESSION <br />SYSTE <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />I 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 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 />NA <br />Owner/Authorized Agent Signature <br />City of Everett Official Use Only <br />PERne� " <br />Date (Revised 1011012018) <br />