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ATIO
<br /> BUILDINITMECHANICAL I PLUMBING/CSIGN /SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> IIMEMIMIIMIMMing
<br /> PROJECT SITE ADDRESS: 6:1500. ./..4^Z,6„,72,52:7_,./liw4Yl PROPERTY TAX#: 0639300 00/5 c
<br /> T
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ��fpjp,c.) )2::).9z._ T 7 ZZ e_ TENANT BUSINESS NAME(Commercial):”
<br /> OWNER MAILING ADDRESS: STREET 0. ,3/,2 ,..- g,.' pe
<br /> cITY -7j C - 1,./, 9-8/o3 STATE 4y,4- ZIP .t✓/Q 5
<br /> OWNER PHONE: (2,C6)6/95 rj3- OWNER EMAIL: TJp ,,..9-> Gbh ii,79-/z_, et
<br /> CONTRACTOR NAME: vim-/raj-7J,e, (0jIL5Zr<
<br /> CONTRACTOR ADDRESS: STREET ,1-.. /, ,r IV ¢Z.1—/,r,, _�,l 449=7' /0...."---
<br /> CITY
<br /> 0�CITY ! — 00 .- STATE 440 ZIP 984
<br /> CONTRACTOR PHONE: �.�0>5 —Lf 'CONTRACTOR EMAIL: 07/6 ,'G'CO S'T i0 5 CoAe/
<br /> CONTRACTOR LICENSE#(REQUIRED): • t ; % 4, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): •
<br /> PRIMARY CONTACT: 7 OWNER 11 CO RACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2©‘,, 6/Q __t53)-
<br /> Qa,-2:3,./...s0.--) CONTACT EMAIL: Q
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: 4,99 9—lojle._.. --afe.pf7r.7— Contract Price of Work:$3,Z.4.67SC) "----
<br /> Proposed Use of Building: /1201 Cfsf.'L<�y Heat Source: IgGas ❑Electric ❑Other m
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: .Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ECT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> - 1— -7—P 16774•-1G e_c-1 ,2 _ , y-/- 2/.___a-6529z
<br /> pitefrI,o
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION " PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> A/C—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 /> 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'/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 is 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.Th•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 auth•-red 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 - s Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> ��' �--..,_ PERMIT&10( `c^
<br /> "..„7
<br /> Owner/Author'�d int Signature Date (Revised 10/10/2018)
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