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PERMIT APPLICATION <br />EVERETT <br />WASHINGTON <br />BUILDING / MECHANICAL / PLUMBING / SIGN / - ?RINKLER / 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 />PROPERTY TAX#: 00"4I7-0OO4OOq-00 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />/� <br />OWNER NAME: r0r,�71"1 NE N M TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 4735 6gyV IC- T FAI,�G <br />- Crr( G�((ENS—`T STATE t,()A ZIP G�ao3 <br />^^__ <br />OWNER PHONE: `TZ5 445_ 1114Ta <br />OWNER EMAIL: 9AMf0E09A'-`? GMAU6DIq <br />CONTRACTOR NAME: O <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: - ^ p <br />K0_, /ACHPJAA <br />CONTACT PHONE: <br />CONTACTEMAIL: (,�� @ (.t'E DE�G�U�1CS•�)./� <br />BUILDING INFORMATION <br />Existing Use of Building: SI- Q <br />Contract Price of Work: $ <br />Proposed Use of Building: Q <br />Heat Source: Gas ❑Electric ❑Other <br />BUILDING USE: 138FR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family -# Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New Addition emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan�g7e/of Use <br />DESCRIPTION OF WORK: Apb I � JJ of'3 C S%02�� (o rrp{ <br />�j� <br />�'� eX7��t\j'e L wrm or - <br />ASSOCIATED BUILDING PERMIT # (if applicable): J7r I l iTt�oCi r'LS <br />,ASSOCIATED <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING. PERMIT APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fatim <br />tonne <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 />-b- <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />-6' <br />Boiler <br />J <br />Gas Range <br />1 <br />Clothes Washer <br />0- <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />$ <br />Heat Pump&Ductless <br />I <br />Dishwasher <br />Sink -Residential (kitchen,bath,bar) <br />J <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />I <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 />J <br />Water Heater <br />,�- <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />-Fj" <br />Wootl Stove <br />Interceptor-Sand/Oil <br />.�' <br />Water Service (behind meter) <br />j <br />Forced Air Systems <br />Other: <br />Q <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/InserliLog <br />Roof Drains <br />Water Heater <br />SPRINKLER/ SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other. <br />Water Suppression System <br />-e <br />No. of Heads <br />Chemical Suppression System <br />,0- 1 <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 grenfing of a permit only authorizes approved work and no deviafions therefrom. Deviations must first be authorized in writing from the <br />Building Official before being thorized under any circumstance. I am the owner, orl am authorized by the owner of this property to perform the work for which application is made, <br />and / comply with the Stafe C1- tractors Law 18.27 RCW and 296200A WAC. <br />City of Everett Offida/ use Only <br />PERMIT# <br />171 1 ► 1 8 ® - <br />Date (Revised 41152019) �� <br />