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0 PERMIT APPLICATION • <br />BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br />EVERETT <br />/ C C �+ CITY OF EVERETT PERMIT SERVICES <br />G Y G R G 1 3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 I (E) everetteDStaeverettwa.aov I www.everettwa_aovinermits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: j ES i M P, D I S O 0 � <br />yv <br />PROPERTY TAX #: <br />LEGAL for newconstructio_n: Short Plat/subdivision _ ____ _ __ _ __ .._Lot No. (attach -copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: EV0Z( E7Ir (j TQ e €NANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET <br />-crry - SrATE ZIP <br />OWNER PHONE: <br />OWNER EMAIL: r'Ct s-t �. .t,@ 4EV Ir>, • C} f' <br />CONTRACTOR NAME: S-rA-tr j - s "G <br />� f �' - { <br />CONTRACTOR ADDRESS: STREET J 1:, l Z(]. <br />�� iq' <br />i � �1 �1 Q� <br />cnY M ti 1.1 l.. R_01r 'i K- STATE V"' � r zip L O <br />CONTRACTOR PHONE '-f 2-9 0- 1 6 Z <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): 9TAt1AY C ( 19 J, K fJ <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: iKOWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: Y r� s�t �., e �/ �t l . 4 r <br />BUILDING INFORMATION <br />t <br />Existing Use of Building: <br />Contract Price of Work: $ 1 Ll I L- U 0 <br />Proposed Use of Building: ' j l3-.-% t_ I <br />Heat Source: []Gas ❑Electric []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 ❑Chan a of Use <br />DESCRIPTION OF WORK: ((�, (1 <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 />Roure <br />count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />AfC-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,bathbar) <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 I SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Othe, <br />Water Suppression System <br />T <br />lNo. of Heads <br />Chemical Suppression System <br />I <br />lNo. 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 trom 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 <br />Everett OHkial Use Only <br />PERMIT,,ve <br />) 1 — 02_3 <br />Owner/Authorized Agent Signature Date (Revised 10I10*018) <br />