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EVERETT <br />WASHINGTON <br />PERMIT APPLICATION db <br />BUILDING &CHANICAL / PLUMBING / SIGN / 67RINKLER / 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: <br />�i <br />V L I�i <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: <br />TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY <br />STATE <br />ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: WSVvl h. ok <br />CONTRACTOR ADDRESS: STREET <br />CITY <br />STATE <br />ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />..11� <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): F <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: f ( <br />irn C-�ti' 1 <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING INFORMATION <br />Existing Use of Building: S <br />Contract Price of Work: $ <br />�o <br />Proposed Use of Building: <br />Heat Source: []Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial <br />❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair <br />❑T.I. []Sign ❑Sprinkler ❑Demolition <br />❑Change of Use <br />DESCRIPTION OF WORK: <br />f1 i {� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICAT <br />PLUMBING PERMIT <br />APPLICA <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />count <br />ist 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 />Z <br />IGas 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 (Rem el) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans esidential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />IFioor Drain <br />Toilet <br />Exhaust Hpdd (Type 1) <br />lHose Bibb <br />Urinal <br />Exha Hood (Type 11) <br />Water Heater <br />Interceptor-Gr se <br />Waste/Water Piping Repair <br />aust Hood (Residential) <br />Wood Stove <br />Intercepto and/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />Medi Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log I <br />Rod 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 />INo. of Heads <br />ACKNOWLEDGEMENT., I have reviewed this application and confirm the inforr o -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�Onlespproved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any cirner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and / comply with the State Contractors Law 18. <br />City of Everett Official Use Only <br />PERMl n <br />(Revised 411512019) - J <br />/ - 1� -_51p;2L� <br />Date <br />