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• _ BMPERMIT APPLICATIO.
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<br /> BUILDING MECHANICAL I PLUMBING I SiGN / bPRINKLER I 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 J(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT.SITE INFORMATION
<br /> PROJECT SiTE ADDRESS: ° ;;, 0`1.. 1,4 j" ., T_". ,m;, L L,-t) 1, . .4 ',., PROPERTY TAX#: '.:‘,`;;;_:0 ``60 0 1 0 1 '7,-,:,T;
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION .
<br /> OWNER NAME: \S1 —fik 44147.111:iraa PAR k 0 A L p TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET `{ );.? 1-1 F F%r` 4V E s i'E e 0()0
<br /> L CITY S Arrr p.„( STATE YV PN ZIP `I \OA
<br /> OWNER PHONE: 7,(') ` -K , t 5 7 ,l OWNER EMAIL:
<br /> CONTRACTOR NAME: jam 4314 , s4°4:+g, al,,),G,
<br /> CONTRACTOR ADDRESS: STREET c/ 9 a-l ji 6#/ JQ ,/ .�6,V.O 5.r-
<br /> CITY �,;iki . ;',�tt L'rr i 1 STATE lb ZIP VS f
<br /> CONTRACTOR PHONE: f -g 5'o' _c 5 5 CONTRACTOR EMAIL: Ai, (; D ,;?r'L{;i '.wI . a.. 11°c
<br /> CONTRACTOR LICENSE#(REQUIRED): at)i f,.°j" 'R,'M q "a t CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 52:5 1 ci
<br /> PRIMARY CONTACT: 0 OWNER G. CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ?O a _ z,.5`z.._Q 0,t
<br /> N.? L;,c,N',, CONTACT EMAIL ",,,, a 4,€,0 e' r' f_' ' 11,t c,,:saAl.
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: fj)4,,,f/_# ? l ) ,vf Contract Price of Work:$ 156 2
<br /> Proposed Use of Building: P4c447, -pint 4, Heat Source: ❑Gas 'Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ® ulti-Family-#Units:5'-• ' ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition aemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use
<br /> DESCRIPTION OF WORK: s , «,) j -; ac,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): N I
<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 /> 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(Rerriodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatlor\ 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 /> 1
<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 /> PERMIT#
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<br /> 7/2 C..) �2- 1 - ID23
<br /> Owner/Authorized Ag t nature ate (Revised 4/15/2019) I /�
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