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MIN PERMIT APPLICATION
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<br /> BUILDING/ IllibLEHANICAL/ PLUMBING /SIGN /SI■INVKLER/ DEMOLITION
<br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue_+ r Black ink Only,Pleasel!.,.., l PROJECT SITE INFIDRMAT10N, ..s. ....,.'. ...... ,,.15,:' ,4,-',,,-'' ,.r..... .,.
<br /> PROJECT SITE ADDRESS: C2,1 v' MA-V\ 64— PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ,,.,.; .. ..... :. . . ,,., . GON"IiAC�'FJINPORM;i4Tlb1S1. . < .. .
<br /> OWNER NAME: I/'tp r; 1 W-,\\,,,,...S TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 9 l t W js
<br /> CITY i ve_.,( .i STATE V ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME. CAM LLC_,
<br /> CONTRACTOR ADDRESS: STREET R 14 ©kNlvv i C -B\ UA
<br /> CITY 1 v 21 "- STATE \Af A ZIP 9V?ZCt3
<br /> CONTRACTOR PHONE: 212.5- Y(v-- 17'7'7 CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): 'P i I lk '1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):51
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: Li 2s--- Lig fi (e - ('7.7'7
<br /> M\ VF C kcvx-t CONTACT EMAIL:
<br /> iB ti*DiNIG;iKP(:RNIATION. , .. , ,
<br /> Existing Use of Building: (k--WSV Contract Price of Work:$ S
<br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: OCommercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> P66,1 Vn I s A La,n S; J`L
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> .. MECHANICAL PERMfT APPLIc,T10N.. .,,,., . .PLL1MEING,PE.R IT`APPL(CAT10N ,
<br /> FixtureFixture Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer / Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher V Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> SPRINKLER,/SUPPRES,SION,SYSTEM,,,: ,, Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System 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 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 WAC.
<br /> City of Everett Official Use Only
<br /> / 4,6,„
<br /> -3 1 r ( PERMIT#T l (07 — eD tner/Authorized Aure Date t (Revised 4/15/2019)
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