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MI PERMIT APPLICATIO
<br /> BUILDING MECHANICAL I PLUMBING I SIGN 1 RINKLER I DEMOLITION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> WASHINQTON (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 /> .PROJECT SITE ADDRESS 1:,k{. P,I M A L . gL 0/, Y FPROPERTY TAX#: .,`!o 5 \`iSa o )O t �°i 0 O
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION'
<br /> OWNER NAME:Ms\l , ...rA `'t g `fthf W PA k in t L I TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET t 0 0 7i FT p 41V E j;L F r, (
<br /> t
<br /> CITY SE,des' "{`L, STATE k ZIP `^ g \0 4
<br /> OWNER PHONE: ?O a o 9 k -5 . 1 OWNER ENTAIL:
<br /> CONTRACTOR NAME: ) v,,a4 ,' x` A g.11CO
<br /> CONTRACTOR ADDRESS: STREET 4E90 & t //JQ A/ $1,V.0 -rE'
<br /> CITY /4 Arm 'A. C I-fit,/ STATE 10 ZIP $'57/ti
<br /> CONTRACTOR PHONE: `r' -g ;,` ^ --0 ,CONTRACTOR EMAIL: ' ,,N, 4�, )),1, 2:�. i Al 6„ YYYYYY
<br /> ti " B 7-.r 9
<br /> CONTRACTOR LICENSE#(REQUIRED):;,";r� ..k���;�� ` , CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER I3 CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2.D 4, _4Z,5"2 _00,
<br /> Vt:at„k-\? Li ,F> CONTACT EMAIL: per, 9
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: f v,l,a„ '; - s/'i e tl,q Contract Price of Work:$��4/ Z g
<br /> Proposed Use of Building: /%;',) "/ �_'r=/7'1 U4, Heat Source: OGas Etlectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse �O,�*Duplex ❑ADU C Multi-Family-#Units: ‘ ❑Commercial DAccessory Structure
<br /> Type of Project: ❑New DAddition LRemodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: t",,i<..,,ar" tt ,?Ea la LID , t [.) 4-6 1 10 1 ' ),°O I9 ._0 R ,7 ii = A
<br /> AN as n p; p e go
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): a\) ,P4'~'..
<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 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 !I Water Heater
<br /> k
<br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump I Other:
<br /> Water Suppression System { :No.of Heads
<br /> Chemical Suppression System 11 No.of Heads. bI
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must u.rnply 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.f 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
<br /> 7 ,91i PERMIT# 7 ebb l - 6 l
<br /> Owner/AuthdAgent Signature 7Date�d Meta/sec/4113/221t9) i
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