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<br /> !lIl ' I PERMIT APPLICATI
<br /> BUILDING'] MECHANICAL/ PLUMBING /SIGRINKLER/ DEMOLITION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> K 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (BI;We or Black Ink Only Please) ,PROJECT SITE,INFORMATIO .,.,,.,.I `A , .. l ., ;. z$ iti ._......
<br /> PROJECT SITE ADDRESS: 7 l /bst i„ (L j E t/PC(rfi- 1A✓4 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision yam' ``^ `N. Lot No. 'yy(attach copy of long legal description)
<br /> .�. gi' . :••..i . ..• .. , ., ..?,...t ...,. , ..0ONTAYT1NFORMATIOst .t ;'; cv .3. .,i. , . _ _.a.,. t a e. .
<br /> OWNER NAME: 1/I I\5616, SQcw,)((( I ® TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 71 R /OS I v l 1 3 i /]
<br /> CITY Eve ce.A- STATE WA ZIP ill 2. 7 I
<br /> OWNER PHONE: b'.Z 5 2 6 0 -cci2 0 OWNER EMAIL: . X0.0 Z.Fi 2 ,Gi 1 . C 0 vIl
<br /> CONTRACTOR NAME: /I/6 Me- (c r 7(),//1-{AC—Of5-
<br /> CONTRACTOR ADDRESS: STREET A.2 p De/"c V Iwl I C(Alivi a N VI/s��f� 0
<br /> CITY tui a l f STATE VY A ZIP `'t 7 7 1
<br /> CONTRACTOR PHONE: 266-qt/6-S 6 5 16 CONTRACTOR EMAIL: III P X A �"/ry �C�j(C£' V1+{/cny C Ni s,6 i r
<br /> CONTRACTOR LICENSE#(REQUIRED): OLj - !? 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �lJ 2-f z....—
<br /> PRIMARY
<br /> =PRIMARY CONTACT: 0 OWNER IU'CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: �'7 G C-G/gh ...c 56
<br /> CONTACT EMAIL: �1 v g//offe'ea✓e 644/Gcteh/S, 16.yo
<br /> .,..,. .,. .Tt #.. . • .,,. R I4p SIG. *ittLRIM ►;Ip ..z,... r ,< . , .
<br /> Existing Use of Building: Contract Price of Work:$ 4/0-00
<br /> Proposed Use of Building: Heat Source: Mas ❑Electric El Other
<br /> BUILDING USE: VSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: El Commercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition l:gemodel CI Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> q al(� IA as61(
<br /> \Q 6✓I 90, 0 4 3O kl k /Prj IA/c✓fe-C /ec 4el-
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL#0.RM T APPLICATItlNg.. ....... BMR PPERMLT APPLICATION .N' u.. ,
<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 'Z Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler I 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
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<br /> Exhaust Hood(Type ll) 1 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 /> _,s ,SPRINKLERI tiilORESSION SYSTEM Sewage Ejector or Sump Pump Other.
<br /> Water Suppression SystemNo.of Heads •
<br /> Chemical Suppression System I 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.lam 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 RC W and 296.200A WAC.
<br /> City of Everett Official Use Only •
<br /> PERMIT
<br /> 11/ • — /— C.--- 265® yy\Ibo \. , 0 \L
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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