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PERMIT . PPLICATIO
<br /> BUILDING 1 MECHANICAL I PLUMBING I SIGN1PRINKLER f 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue,or Black Ink Only Please) PROJECT SITE INFORMATiON •
<br /> 'PROJECT SITE ADDRESS: 10 0,''''' ,',;) MA L.L 1 L�L?. 1 PROPERTY TAX# ' 0 5 ci O1 o _1 O 1 -7 o c'a
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION •
<br /> OWNER NAME:M v.:,-MC, 4,4m i'lt,4'r-,.)1 Pj ilk 0 t L pTENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET '6,0 .) 7f F Tl 4V,+° STE f c 4k* ` ) `
<br /> CITY p`° A`i` ' ,,, STATE ZIP 'b 1 V jt
<br /> OWNER PHONE: 7 t S
<br /> 7 L OWNER EMAIL:
<br /> CONTRACTOR NAME: tol,CD146 'k::c',z t.r, I.:1 RI1,
<br /> CONTRACTOR ADDRESS: STREET tit: 0 (,v o41I N0 rAJ 51-V.Q 1-r-E IS
<br /> ciTY At3 M ya'7"�/ STATE /t) zip 7371 ci
<br /> CONTRACTOR PHONE: Zoic-a 59, -- j' CONTRACTOR EMAIL: ;"ricD.;@ i .L._,.ratios,_Cio#.1
<br /> CONTRACTOR LICENSE#(REQUIRED) p A;i .,F,tv9 q 9, ,) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ..3 4i 9
<br /> PRIMARY CONTACT: El OWNER D CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: /0 6 e c=6 5yy 1,_00 tq
<br /> i4.q.),-\ v,01 ii> CONTACT EMAIL ° a/CAL_" ,'g l.P' ., e.+' M
<br /> BUILDING iNFORMATIOI5I
<br /> Existing Use of Building: j/'r',,L,r',' _ ,�-- °i:,i s „'.1 Contract Price of Work:$ ✓✓ �/'ti 5I
<br /> Proposed Use of Building: Pal td 4,7 P -r , ri l 44yi Heat Source: ❑Gas Eltlectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change;of Use '
<br /> DESCRIPTION OF WORK: n, tilt t:cac.. i }`Ts, t. (a E . 6 11 ", I ‘.0 1 'i . \L 1 'T()f Z` F •-1 =.6
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): IQa.a'..
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture
<br /> Count List of Fixtures Count Fixture 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.ofjear)s
<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 1 comply with the State Contractors Law 16.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> /� o of — 1.
<br /> Owner/Authoriz A ent Signature g g O e (Revised 4/15/2U19)
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