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EVERETT <br />WASHINGTON <br />PERMIlT APPLICATION <br />I OLIDIgAIG PMECHANI ICAiU I PLUMBING I SIGN 106FRINKLER / DEMOL0T1 DN <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 air Black Inca (Only plasma) PROJECT 0ll d r mr-QRMATOON <br />PROJECT SITE ADDRESS: �V ��� PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision AV) 5 Lot No. (attach copy of long legal description) <br />CONTACT 11400RNIATil <br />OWNER NAME: GLIVER, 0jVe!&rMAFf\.)aNANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET G 0,,C�R eAk <br />CITY STATE ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: <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: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: P;,�( (�,�1� <br />— `4� <br />ONTACT PHONE <br />CONTACT EMAIL: <br />'BUILDING. INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: N15-a—s WEre"e'tric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse []Duplex ❑ADU ❑Multi -Family -# Units: We<&rcial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair Q]X!r.'— ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WO K: 76 <br />O'�1A) -b>.1• ►��.�a�w+ tit. >•'rn�t►'►v�t �ccM �'3 S%awvl c 4ei►�s <br />^tAA> -fT tfKd� N�tw� kJlo�. <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT APPLICATION <br />PLUMBINCSr PERMIT <br />APPhlCMOOI21 _ <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 II) <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 />is Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER / S'UPPRESSIQN <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. / 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. 1 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 Onl <br />(Revised 4/15/2019) l y <br />