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Nisi PERMIT APPLICATIO
<br /> LI
<br /> BUILDIN HANICAL PLUMBING /SIGN INKLER/ DEMOLITION
<br /> EVERETT PERMIT SERVICES
<br /> EVERETT 3200 CEDAR STREET, EVERETT,WA 98201
<br /> WASH INGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Buie or.Black ink•Only P,leasa).: . . ..,.:i..PROJE T SITE,IINF,ORMAT>ION ,..... . ,...... . ,.r . , .a,.
<br /> PROJECT SITE ADDRESS: L//(P 41 er c'al PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> . . . r ; GONC'TTAiN�QRMA►T101+�. �-< .... <,.
<br /> . .
<br /> OWNER NAME: 6q 4-h y .I f i's TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET ��/6. A I U U,SOn y�
<br /> CITY E(J Pl C 7L STATE Lj ZIP ,V'')C"I
<br /> OWNER PHON <<ZS„,) : OWNER EMAIL: J(', ;f, ktorr'y
<br /> CONTRACTOR NAME: $e4 (ov K c e P)`''1 C-60) P7 A q7%�y
<br /> CONTRACTOR ADDRESS: STREET PO Bo.)( / Lc3'- / /
<br /> CITY / ` 7•S tf t I( r STATE w 4 ZIP //�g2
<br /> CONTRACTOR PHONE(C/?S). O' /2q CONTRACTOR EMAIL: ..,]4 t"neS� I 1 a sic e/0) AT 3 �,r +0
<br /> CONTRACTOR LICENSE#(REQUI' D) 4.4 4 N F. : / CITY OF EVERETT BUSINESS LICENSE#(REQUIRE^ •Co O
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: (<72...03~-0 E 0)2 c7
<br /> -GL t” 2S kiet5oti CONTACT EMAIL: 3a wie s bpi /a h c{/0`v,+ScG IV,°ces co
<br /> .. ,BUILD:II+1G..INFORMVlATION .... ' .
<br /> Existing Use of Building: 3 4 -] r $ —
<br /> Proposed Use of Building: Heat Source: G s tric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition 0 Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: o
<br /> e 1q c co vt GI e✓►$:.,f, -��n / K ae u ` .4-G� Y► +t/ P - �S.S 6 6-vad,,o ,.I
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> 1VlECHANICAI.PERMIT A,PPLICATitfld ._ >. .. PLNMRMNG RERIIAIT AP..PLI@4T>0,,-N, ,
<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 Ventilatior 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 /> ::r, SP.RINKLERI SUPPRESSION SYSTEM ..j 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 /> PE M #
<br /> acce _,tNict 2.___
<br /> 1.,4,1, 9M4L/e/A..
<br /> Owner/Author e Agent Signature Date (Revised 4/15/2019)
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