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• 0 <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL I PLUMBING I SIGN / SPRINKLER / DEMOLITION <br />E T T CITY OF EVERETT PERMIT SERVICES <br />EVER3200 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: 9910 Evergreen Way <br />PROPERTY TAX #:0134247 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: TENANT BUSINESS NAME (Commercial): BUZZ ) nn <br />OWNER MAILING ADDRESS: STREET9910 Evergreen Way <br />C,n Everett STATE WA zip 98204 <br />OWNER PHONE: 425-359-0632 <br />o WEIR EMAIL: memisty6@gmaii.com <br />CONTRACTOR NAME: -Day and Nite Plumbing and Heating <br />CONTRACTOR ADDRESS: STREET16614 13th Ave W <br />CITY Lynnwood STATE WA ziP 98037 <br />CONTRACTOR PHONE:425-775-6464 <br />CONTRACTOR EMAIL:IOri@dayandnite.net <br />CONTRACTOR LICENSE #(REQUIRED):DAYNIPH944RQ <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 019741 <br />PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑ OTHER (Please Specify) _ <br />CONTACT NAME: <br />Lori DeFoe <br />CONTACT PHONE: 425-775-6464 <br />CONTACT EMAIL: lori@dayandnite.net <br />�dayandnite.net <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: ❑Gas OElectric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex EIADU ❑Multi -Family- # Units: Z✓ Commercial ElAccessory Structure <br />Type of Project: ❑New DAddition ❑Remodel ❑Repair EIT.I, ElSign ❑Sprinkler ❑Demolition OChange of Use <br />DESCRIPTION OF WORK: <br />Adding a 1/2 backflow device for mop sink. <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 />1 <br />Backfiow 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 HeaUAC 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 />WastefWater Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <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 <br />/ SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />17 of Heads <br />Chemical Suppression System <br />jNo. of Heads <br />ACKNOWLEDGEMENT: 1 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. f 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 />a\ C <br />) 1 O \ <br />Owner/Authorized Ag Si re Date (Revised 1011012018) <br />