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• i <br />PERMIT APPLICATION <br />EVERETT <br />WASH►NGTON <br />BUILDING / MECHANICAL / PLUMBING I SIGN I SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 ( FAX 425-257-8857 j (E) everetteps@everetlwa.gov I www.everattwa.gov/permits <br />Blue or Black link OnIj Please 3 PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: r <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: tt..l Cat C TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET I ICE) -' :� - -' L&A� <br />CITY > STATE MP <br />OWNER PHONE: "" <br />OWNER EMAIL: <br />CONTRACTOR NAME : iJt2 _ 7• j . A <br />CONTRACTOR ADDRESS: STREET <br />CITY ,\/ : " STATE CIA ZIP 77 <br />CONTRACTOR PHONE: crgJo Z /L& <br />CONTRACTOR EMAIL: ���' � ��� SS�LLt✓'l�' � f� <br />CONTRACTOR LICENSE #(REQUIRED):,- JI (p 5:�' F 7Z67 T_" <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED):( . 7' " <br />PRIMARY CONTACT: O OWNER CONTRACTOR © OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: ((f <br />CONTACT EMAIL: _:5m h-to" Q OWL <br />BUILDING INFORMATION <br />Existing Use of Building: I <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Neat Source: 0Gas Electric ©tither <br />BUILDING USE: C1SFR 0Townhouse ❑Du lex OADU ❑Multi -Farm - # Units: IX6ornmerclal DAccessory Structure <br />Type of Pro ect: ONew OAddition ORemodel ❑Re air ❑T.l, ❑Sign C Sprinkler petlnolition OChan a of Use <br />DESCRIPTION OF WORK: 12q.-iC.ic' c * � VsTuv^ H � 4- v ` aww� %/ e2z) 41'<�fT- llC3 <br />t In (,A" -10 CAROA as ex� <br />ASSOCIATED BUILDING PERMIT # if ap ticable : �' �� ��S LUX"" ccntne., <br />igg <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 ofFixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />Last of Fixtures <br />NG -• Air Handling Units <br />Gas Pi Ing <br />Backilow Preventer inside Btdg <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,preP202r <br />Clothes dryer <br />Heat Pump&Ductless <br />dishwasher <br />Sink-Residentiai (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 (rype i <br />hose Bibb <br />Urinal <br />Exhaust Hood (Type 11 <br />Water Heater <br />Interceptor -Grease <br />Wasta/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/OII <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/inserl/Log <br />I <br />IRoof Drains <br />Water Heater <br />SPRINKLER I SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System I <br />IMo. <br />of Heads <br />Chemical Suppression System I <br />jNo. <br />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 authorizers in writing from the <br />Building Official before being authorized under any c1mumstence. I am the owner, or 1 am authorized by the owner of this property to perform the work far which application Is made, <br />and l comply with the Stato Contractors taw 18.27 RCW and 296.200A WAC <br />City of Everett Official Use Only <br />PERMIT # <br />Owner/Authorized gent Signature Date v/sea 10110I2018) <br />