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MIMI PERMIT APPLICATIOI`' <br /> BUILDINGGVIECHANICAL / PLUMBING / SIGN WPRINKLER / DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 I (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: D j F Lfe rG���Q h U)iltf PROPERTY TAX#: 01 12 5SC/` <br /> LEGAL for new construction: Short Plat/subdivision J t Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C Nti i n ue6fi CO/A/Are j In( TENANT BUSINESS NAME(Commercial): l„{j 1 l/1 WI b <br /> OWNER MAILING ADDRESS: STREET PC) BOA 1I.)00 <br /> 1 it 1-— CITY e,J,' k-1- STATE UA ZIP ( e l ay <br /> OWNER PHONE:1 - " a5 - Ig I 1 OWNER EMAIL: (J//4 fff <br /> CONTRACTOR NAME: � P� J � I N� rk. <br /> CONTRACTOR ADDRESS: } STREET a(�0� f-i'(,(} J 99 SOX( <br /> CITY rrr. eV fb f / STATE LOP' ZIP .8)a 7 3 <br /> CONTRACTOR PHONE: 3(t9i3- 4(4- j ja 5 CONTRACTOR EMAIL: Persil i f5Q /J7 rSiIn•CL n <br /> CONTRACTOR LICENSE#(REQUIRED): 1'!t-W A5c$3Z3'' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57310 <br /> PRIMARY CONTACT: ❑OWNER t4 CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME <br /> (� CONTACT PHONE: Ae0--9G�- )jy6 <br /> (-1 n( tau t'ar re CONTACT EMAIL: . V flh i f? ( fyietie'Sfl• clom <br /> BUILDING INFORMATION <br /> Existing Use of Building: CIOimeti Contract Price of Work: $ •t)"C) <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ElDuplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> RACE cn) -V,n1 aot bft ( ..cd I l 1,. i;-()ii,i ' d' I-e f, <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 Lis�f 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 H)" Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air stems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fir place/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I 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 /> / �— 5I� <br /> PERMIT# s2....1 � 3 _ 0 o 1 <br /> killrOw r/Author d Agent i nature Date (Revised 10/10/2018) <br />