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MI PERMIT APPLICATIO
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<br /> BUILDING ECHANICAL/ PLUMBING /SIGN RINKLER/ 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: I Dr, PROPERTY TAX#:Z t'{I 2.00 �I COS
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: M�'` f M M..6 S `T TENANT BUSINESS NAME(Commercial): L v'w,\ C_5 i.-I—CS
<br /> OWNER MAILING ADDRESS: STREET SO k l-)t- S 4 • S
<br /> CITY ?\,L\I,,,i1 ,kp STATE W A ZIP qE37 _
<br /> OWNER PHONE: 5-3 3)8 -- 6, , 2 OWNER EMAIL: esrLc) 25 -i-a..-i-est Z2S Z 14,1C4_+ 1. co,......,
<br /> CONTRACTOR NAME: j(kSe v.N 1-i LE' o.} �0.:` /0.- I Cv•s 'IY C U. -k-O1.t
<br /> CONTRACTOR ADDRESS: STREET .7 1 Z. N VJ `ec 54,-e A-
<br /> CITY 'e C' 4" STATE w Y\ ZIP9O II-
<br /> CONTRACTOR PHONE: 201E - (4 (^ D3 S5 CONTRACTOR EMAIL: NPct\\&' A5 }►c:vlSedvicej qv^'Itul,t'o-%
<br /> CONTRACTOR LICENSE#(REQUIRED): 13A1-1-Ac-S g'7jZ
<br /> C 2. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): &v)
<br /> PRIMARY CONTACT: `n OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2 C 3 - 31B _ c Z
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<br /> tr\(s;c 'Mc i\r%CQ S-,cc v CONTACT EMAIL: ,,r k,,; ,.1 ec 4t4-,5 g2 2-S"Ci evict, •(>c't.,-.-,
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: IN 1 c &J cwl e..•}- Co,^^V Contract Price of Work:O. 0, 66
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU I Multi-Family-#Units: S ❑Commercial ❑Accessory Structure
<br /> Type of Project: ONew ❑Addition ❑Remodel 1$Repair ❑T.l. ❑Sign OSprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: Kai•,5\-eN C4- -c\- ^.re, �cxV-k✓'5 ► A. bekwee•,A �p
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<br /> c „C,�ne,d -or- �,�� u...0 - #0 be. 1 Cb.r.?lz,+cd.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<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(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.of Heads
<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 /> ,1 `—Zn emey,. 12 )3/iq PERMIT# l l�
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) f
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