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IMON PERMIT APPLICAT <br /> az <br /> BUILDS, MECHANICAL/ PLUMBING /SIG-I / SPRINKLER/ 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: C C i ej('LCck,\ ,Ck,. A- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: NV CI AC'&_._ ei2A ,cVcuL <br /> CONTRACTOR ADDRESS: STREET `=2.2 �B! '7 (C\• j C / �n/�v�^� j r� <br /> CITY G.�.U�J € MI 0 6 VS `� e,CP�V 1 "'�`TE \OCA ZIP �V ,I <br /> CONTRACTOR PHONE: Nos; (qZ,S'-E id, CONTRACTOR EMAIL: 0Vcor\1-r9thc r L\ Gki yv <br /> CONTRACTOR LICENSE#(REQUIRED): E, 4J (C �1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRE . <br /> PRIMARY CONTACT: OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTAIpT ME: /`, CONTACT PHONE: `T( S- E L- -774` ..( VI'I1IV) <br /> V IL ( r i0 1' L fJ CONTACT EMAIL: C> 'vC�C- ,1'l[ W`Lk. cU<_ J 4U,r(, ,(;C?r1t <br /> BUILDING INFORMATION <br /> Lio <br /> Existing Use of Building: 1N\-�t ' 'Gv <� ` Contract Price of Work:$ 3000• <br /> rn� ( <br /> Proposed Use of Building: , .ti., k� S Cb'v1Ni� Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑A U Multi-Family-#Units: Y ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: - ' <br /> y ‘k 5�Lo S o Q c+v(Ncr� k<< c�C-e.x,�,�`f pill l/ � � <br /> vI �; <br /> ASSOCIATED B ILDING PERMIT#(if applicab ): <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 /> 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 Ventilatior 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 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 /> / 1 PERMI <br /> 2OIr02(a <br /> Owner/Authorized Agent Signa ure Date (Revised 4/15/2019) (ik <br />