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MIMI PERMIT APPLICATI
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<br /> BUILDINrNECHANICAL I PLUMBING /SIG RINKLER/DEMOLITION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Byre a .BlaOk liik144160:Wase) ,,;,•PRO 0.CSITR tNFORIwAT>IO>+ •,,N.,• •„ '
<br /> PROJECT SITE ADDRESS: _IOS /`10k <5 on Agii, ST PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT il4#001A'.T-IO0 . . . .
<br /> OWNER NAME: T(h S"comer TENANT BUSINESS NAME(Commercial):01061 3 o/\ Atypc pt.),'Np
<br /> OWNER MAILING ADDRESS: STREET Q OS (41 7•50/' Sr
<br /> CITY .�J ` '•ere,\As STATE IV ZIP cWZO
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: C k& . \S
<br /> CONTRACTOR ADDRESS: STREET (pN1 �© V\P`(`(\t \,, s
<br /> CITY€1./eNeAA STATE W - ZIP ei�
<br /> CONTRACTOR PHONE:45- 353 444 4 CONTRACTOR EMAIL:' Q4',C MQ Ck\ � ( + %CC
<br /> CONTRACTOR LICENSE#(REQUIRED) ` ..t Ck \Amok& CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):t3C)1C:i ti
<br /> PRIMARY CONTACT: 0 OWNER 5KCONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4 . js4 444
<br /> Rjc\A WM\L CONTACT EMAIL:\c „k NA,..,' (. L.4,,,,,„,,, ,CoQ
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<br /> .Marr. a a�.Iw�pRlu�araor� � ,: .
<br /> Existing Use of Building: N:113f a.% Q , Contract Price of Work:$ 31e°_X')
<br /> Proposed Use of Building: c `CA Heat Source: )4as 0 Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> 0 C'k - V—\CNNQN \ ,tA t Elcis\Do 4.01-' c1V%—N'
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> `' MECHANICAL PERMIT API*1 AtiON.,
<br /> E „ ; . , ... ° P,L4NIBIN.0PER0l"r"0PLI0.A'I"1ON:, .... .. ,,,., . •,
<br /> Fixture Fixture 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 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 /> X 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 I SUPPRESSION 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
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<br /> CLJ`� `k 'C PERMIT# mVocQ—O2 \
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<br /> Owner/Authorized Agent Signa ure Date (Revised 4/15/2019)
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