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EVERETT <br />WASHINGTON <br />PERMIT APPLICATION, <br />BUILDINGOECHANICAL / PLUMBING / SIGN I _ INKLER / 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: 1 �- I <br />ILA SW pvl� 77 O203 <br />PROPERTY TAX #: OD 361-- DDO --O�rDpO <br />LEGAL for new construction: Short Plat/subdivision H W-_jq w (�"� r�l� MPOL.ot No. •0 (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: D( r-A LviwAmA TENANT BUSINESS NAME (Commercial): hl .6 <br />OWNER MAILING ADDRESS: STREET 2 I 113 <br />CITY Y (� STATE WA ZIP `LG <br />OWNER PHONE: (42-) 324— ++oI <br />OWNER EMAIL: �-Gi��cLEi` W G j�i�,(�;� <br />CONTRACTOR NAME: 0� <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: M OWNER Q CONTRACTOR ❑ OTHER (Please Specify) _ <br />CONTACT NAME: <br />DOM i VII&NAMA <br />CONTACT PHONE 7 4G�p <br />CONTACT EMAIL: I Q <br />uPWi',I1ui Q i I''rt=a • Ga►i—•- <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: ❑Gas XElectric []Other <br />BUILDING USE: 'SFR ❑Townhouse []Duplex ❑ADU []Multi -Family-# Units: ❑Commercial ❑Accessory Structure <br />Type of Project.: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler []Demolition []Change of Use <br />DESCRIPTION OF WORK: <br />IpTo A.04A • ; FP77f�76-r A-k--A 200, 5; Sr <br />i� aTl ni utsTir7i 6A7?.A.��_; No P%fc� fOoTiif Oft NO PF% 4P NT , <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL 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 />pcpiping <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 es Dryer <br />Heat Pump&Ductless <br />Dishwas he <br />Sink -Residential (kitchen, bath, bar) <br />Duct em (Remodel <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust (Re K ntial) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood e 1) <br />Hose Bibb <br />Urinal <br />ExhaustUsed' (Type <br />Water Heater <br />Interceptor-G e <br />Waste/Water Piping Repair <br />Exh Hood (Residentia <br />Wood Stove <br />Interce and/Oil <br />ter Service (behind meter) <br />ced Air Systems <br />er: <br />al Gas <br />Wa Ives or Fixtures <br />G4 <br />as Fireplace/Insert/Log <br />oof Drains <br />Water He <br />SPRINKLER / SUPPRESSION <br />SYSTE <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 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 />City of Everett Official Use Only <br />Owner/Authorized Agent Signature Date (Rel,,sed 7U/7"L _ , <br />