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• <br />PERMIT APPLICATION <br />EVERETT <br />WASHINGTON <br />BUILDING I MECHANICAL I PLUMBING / SIGN / SPRINKLER I 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) everetteDS everettwa.aov I www.everettwa.anvinarmits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 3 V E.51 M & D I S 0 C- <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: LVEILE C)'S j YJ is At44fNANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET p c j b �, <br />�� /jj <br />CRY Y —�L.. STATE V I % ZIP 'j 0 <br />OWNER PHONE: <br />OWNER EMAIL: rQ !'� <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET I &.'Ct 1 7- q <br />cm' 1 1 C STATE L^J A ZIP q6 9} ( ! 2 <br />CONTRACTOR PHONE c(2 2, q — % t>Z <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): '5-rMZ CZ 19 5, f 1�. I f <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: WOWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: vet e J k'4 . Cb • P <br />BUILDING INFORMATION <br />Existing Use of Building: �tM ems}" <br />Contract Price of Work: $ L- O <br />Proposed Use of Building: ' j a-.M C— <br />Heat Source: ❑Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU []Multi -Family -# Units: ❑Commercial DAccessory Structure <br />T pe of Pro ect: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition ❑Chan a of Use <br />DESCRIPTION OF WORK: <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 />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 Ventilator <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 FireplacellnsertiLog <br />Roof Drains <br />Water Heater <br />SPRINKLER I 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 I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br />t City of Everett Official Use Only <br />Lf '' Z � PERL45 #n' <br />Owner/Authorized Agent Signature Date (Revised 1011012018) <br />