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EVERETT <br />WASHINGTON <br />PERMIT APPLICATI <br />BUILDI ECHANICAL / PLUMBING /SIGN , - R,NKLER / 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 />toll i. <br />PROJECT SITE ADDRESS: f t e <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT 1MFOR6t11�T�ON . a ,=k , , <br />OWNER NAME: TENANT BUSINESSNAME (Commercial): <br />OWNER MAILING ADDRE STREET It 0 0 ve <br />CITY i STATE A ZIP <br />OWNER PHONE: Z.©G ( % ZZ- <br />/ <br />OWNER EMAIL: cxee <br />CONTRACTOR NAME: K <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />�C <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />I±ORMA7iON , 3 <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: ❑Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse []Duplex ❑ADU []Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign []Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: M o t ie- 5e4 &Cn f X ij -e� a Vle—� Q.L-' a/- U/' <br />K-,06?0 e'--we, <br />ASSOCIATE BUILDING PERMIT # (if applicable): <br />MECHANICALPERMIT <br />APPLICATf01<+1, <br />, t:. <br />F.,. ,,.t..:., PLUMBM�I�; PE RMIT,APRLICATIQNF;,,....., <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 />I <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 />rinking Fountain <br />Sink Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatlor <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 />WasteM/ater Piping Repair P <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/InserULog <br />Roof Drains <br />Water Heater <br />$PRINKLEi� 1, SUPPRESSION, <br />SYSTEM , „_,, <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System I <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 wun <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 comely with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PET <br />(Revised 411512019) <br />