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PERMIT APPLICATIO <br />BUILDINGAIECHANICAL / PLUMBING / SIGN RINKLER / DEMOLITION <br />EVERETT 32CITY OF EVERETT PERMIT SERVICES <br />00 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (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)PROJECTPROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: III oc 01 t Vcf <br />W <br />n <br />P�1 ff')ROPERTY TAX #: 0 OVC00 a -l00 <br />LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET o`1S qe <br />CITY Utj ?—F STATE zip <br />OWNER PHONE: 4ZSi— 1-'9) 9-(10 <br />IOWNER EMAIL: +r'Y141 l (. Cn n1 <br />CONTRACTOR NAME: �t <br />` ` <br />CONTRACTOR ADDRESS: STREET l� A <br />CITY STATE ZIP <br />CONTRACTOR PHONE: A <br />CONTRACTOR EMAIL: <br />,, cc <br />CONTRACTOR LICENSE #(REQUIRED): ►v <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: rtn <br />VeM'1 V—�ViOk2— <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Bu'Iding: "FCIVkAjk <br />Heat Source: ❑Gas EZElectr c ❑Other <br />BUILDING USE: 121SFR ❑Townhouse ❑Duplex <br />LADLI ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition 26hange of Use <br />DESCRIPTION OF WORK: <br />tN o Covkn.A-,c,%-k�0v---s <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 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 />I <br />10ther: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />I <br />I <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />INo. of Heads <br />Chemical Suppression System <br />I 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 ngContr <br />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 iized 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 wjM t ttors Law 18.27 RCW and 296.200A WAC. <br />uate <br />City of Everett Official Use Only <br />7�o�A <br />✓ oiA, <br />(Revised 1011012018) <br />