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PERMIT APPLICA I IO
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<br /> UIL DING MECHANICAL I PLUMBING I SIGN I SPRINKLER 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 link,Only Please) PROJECT SITE INFORMATION
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<br /> PROJECT SITE ADDRESS: ¶OO" ; W tf\pt L L y & geO/. 2 PROPERTY TAX# ; re 0 5 \`60 tJ 1 O I -i o,f',)
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> . . CONTACT INFORMATION
<br /> OWNER NAME:MS\I F-I'A ndimiJ piwk txm Lp TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 00 7f T T'/ 4V r. 'STE. l 1)r;a )
<br /> CITY .eat"'""F t STATE k ZIP '11S7.VA.
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<br /> OWNER PHONE: ?0 A —it 1 —5 i OWNER EMAIL:
<br /> CONTRACTOR NAME: i i C`51t*46 ' .,'C so`,v � ";,, i v, ,c,,
<br /> CONTRACTOR ADDRESS: STREET `7 Z 9 0 Ai 0 1V t.;i rrA 54,V.O CSME ,, y
<br /> CITY A�;4t, IAi w 1 �0 f't( STATE 1p ZIP 7/cif
<br /> CONTRACTOR PHONE: z,6 iti1-..to ' -015 3 CONTRACTOR EMAIL: in. Cig, c.)f 1, l i .,.cowl
<br /> CONTRACTOR LICENSE#(REQUIRED):1+M 4„F,0CI'I9 6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 52-'5 0 9
<br /> PRIMARY CONTACT: 0 OWNER IrCONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: Z O b -s 5"2 0 c t .
<br /> V. 1d.tm\? z '',) CONTACT EMAIL: `a* , m ) ? -c�A4'--_Atz,r .S` M
<br /> • BUJLI:1. NG INFORMATION J
<br /> Existing Use of Building: MOL.'�'s, E). !` ,ir", Contract Price of Work:$ °l'D D
<br /> Proposed Use of Building: SaouLT 1 --" ;ii 11,,.V Heat Source: OGas EE lectric DOther
<br /> BUILDING USE: DSFR ❑Townhouse ��❑Duplex DADU [Multi-Family-#Units: rj OCommercial ❑Accessory Structure
<br /> Type of Project: ❑New DAddition BlR//emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use
<br /> DESCRIPTION OF WORK: 6/,,,jt3, of F 1: i)'.x . 6,--?,i` i 1 t`�.0 0 , 0�°E I -00 F Fes-1 ,
<br /> AND 4A: .At r 5 .7- F
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): N IA m_
<br /> MECHANICAL P ;FMfi1 APPLIC_ ,T)C ] PLUMEINS PLC"` iT APii' ,ICa3,TIO.)
<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 e •Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatio Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Water Heater • • 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: f
<br /> ,Water Suppression System No.of Heads
<br /> Chemical Suppression System 1No.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#/7/Z0Owner/Authorized Age Signature (Revised 4/15/2l319)
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