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EVtRETT <br />WASHINGTON <br />PERMIT APPLICATION <br />BUILDINGOECHANICAL / PLUMBING / SIGN *RINKLER / 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: I 0 PROPERTY TAX #: 004/777 /76 <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): <br />OWNER MAILING ADDRESS: STREET �p <br />CITY STATE Lf ZIP I'WW 3 <br />OWNER PHONE: ZS, 737 % <br />OWNER EMAIL: ji1�e s1 <br />CONTRACTOR NAME: U S� f LLG <br />CONTRACTOR ADDRESS: STREET % / T 1-1- GJ <br />CITY STATE %1"' ZIP 9Pz 97- <br />CONTRACTOR PHONE: ZS- 7y6. yZ/L <br />CONTRACTOR EMAIL: nGdn-. <br />CONTRACTOR LICENSE #(REQUIRED): COOL j'rZy <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ® CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: / <br />7g01c✓ �irn�G�c <br />CONTACT PHONE: yLs -7 yUZ <br />CONTACT EMAIL: <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: <br />Proposed Use of Building: <br />Heat Source: ❑Gas ®Electric ❑Other <br />BUILDING USE: 59SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ®Remodel ❑Repair LIT. 1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <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 />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 11) <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 />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 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />' City of Everett Official Use Only <br />PERMI # �71, <br />Owner/Authorized Agent Signature at �-� (Revised 1011012018) <br />