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PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / 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) everefteps@everettwa.gov I www.everettm.gov/permits <br />(Blue or Black Ink Only Please) <br />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: <br />A /� <br />PROPERTY TAX #: 0043 $ / 7 -3 j 4W Idd <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No._ (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: <br />6MA6,krIA <br />TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET <br />„ZO 9'k <br />- <br />CnY ,� - (,j <br />STATE <br />�j <br />ZIP 1 <br />OWNER PHONE: ,,5 53 1 " I I <br />r d . G <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />CITY <br />STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />T: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />1_ <br />EHMI lc) ot r <br />CONTACT PHONE: CJ FJ S <br />CONTACT EMAIL: S 1 d Q,) rota <br />BUILDING INFORMATION <br />Existing Use of Building: C.S F.vl <br />u <br />Contract Price of Work: $ <br />Proposed Use of Building: " e <br />- i0. <br />Heat Source: ❑Gas Xlectric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse Ruplex <br />❑ADU ❑Multi -Family-# Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New []Addition &Remodel ❑Repair <br />❑T.I. ❑Sin []Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />/nuke Amino /.Vark9es to d0Ljr 1Sl-arcs, . �� �,1 0 <br />i ��Eor Flan NlAd Move Sae 01rf1faUCes, Minor- clfaNtp/ps 1" (zjo4a#vK- <br />ASSOCIATED BUILDING PERMIT # (if applicable): +U�✓e + C' i' Aft d VQ14I <br />MECHANICAL PERMIT <br />APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fhture <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 />Backli Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial 3-oomp,prep,800r <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen,bath,ber) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mo <br />Exhaust Fans (Residential) <br />Commercial Venfilatior <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 />lWater Valves or Fixtures <br />Gas Fireplace/insert/Log <br />Roof Drains <br />lWater Heater <br />SPRINKLER / SUPPRESSION SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />I <br />jNo. of Heads <br />Chemical Suppression System <br />I I <br />No. of Heads <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein Is two 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 296.200A WAG. <br />I n PERMIT#lCiittyy of Everett Official Use Only <br />^ Z— 05 <br />Owneerrlll/Authorized Agent Signature Date ! (Revised 1011100l-Lb/2018) <br />