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NM PERMIT APPLICATIOVI
<br /> ii.
<br /> BUILDINtIECHANICAL/PLUMBING /SIGN 7161PRINKLER/DEMOLITION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 ) FAX 425-257-8857 )(E)everetteps@everettwagav j www.everettwa.govipermits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 1'23 I _j l 4 Gt. A t/e— e !PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> �,y� �� 42,17441.044.,CONTACT INFORMATIONOWNER NAME: �`�;�fr `,e'r` , TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET I'?i ( c ct.C.if c,PI-Ve, - L f / l
<br /> cnvlP� STATE (�lJ /�-
<br /> ZIP
<br /> OWNER PHONE; `1'25 — 53 Cyr /2-3 OWNER EMAIL; 2*444,„2.0 pv+I ��� /Na , .6--fQ r- c Gym
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<br /> CONTRACTOR NAME: 1 ,A "�' ryt t✓�� 6' ``�
<br /> 1 E CONTRACTOR ADDRESS: STREET 1 j���,,�y ?�� �"� � �f � a
<br /> CITY r�Y a�./K STATE. W 4 ZIP ' .,J,
<br /> CONTRACTOR PHONE: ;, 6 — s t CONTRACTOR EMAIL: ai
<br /> CONTRACTOR LICENSE#(REQUIRED): ktuticLe S L- '?c-f CITY OF EVERETT BUSINESS UCENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER 1 CONTRACTOR gkoTHER(Please Specify) f,tcb ' 4'ell iL.r, (,
<br /> CONTACT NAME: Tow,,(, ( CONTACT PHONE: ap ) 116,s cil
<br /> CONTACT EMAIL: Idt..1,s I r_ 1t� e.Irm l
<br /> BUILDING INFORMATION `u�'
<br /> Existing Use of Building: Audit, I-wt.2i j- Contract Price of Work:$ 1% r
<br /> Proposed Use of Building: � Heat Source: ❑Gas ❑Elec ric
<br /> BUILDING USE: QSFR ❑Townhouse ElDuplex ❑ADU 'Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> f
<br /> Type of Project: ❑New ❑Addition ❑Remod/el ❑Repair CIT.!. Sign ❑Sprinnkklerr�-fir❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: //�� INL;~�6utp t .) t^.ai ta:! ! r.' /�(j` a-/.�'r.Akik�J -1.6,1j iJ , 44-? 4.rs
<br /> °�.f.��{ i.A.M ,,,,,�- .A/i #-.j - to
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING,PERMIT APPLICATION ,
<br /> Fixture List of Fixtures Fixture Fixture Fixture
<br /> i Count Count List of Fixtures Count List of Fixtures Cat 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 /> SGtothes Dryer r 'Heat Pump&Ductless r rDishwasher i' !f ink-Res ictenttar(kitchen,bath,bar) '
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential), Commercial Ventilation Floor Drain Toilet
<br /> ', t`ExhaustHood(Type t) `,(Not;Heat/AC system), ,*lose:Bibb 'Urinal
<br /> Exhaust Hood(Type II) 'Water Heater ,Interceptor-Grease Waste/Water Piping Repair
<br /> • 'Exhaust Hood=;(Residential) Wood:Stove Interoeptar nd/Oil WaterServioet(beiiind: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 Sta a Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> y '''/ _ PERMIT � ( (® '6°
<br /> Owner/ orized gent n re Date [Revised 10/101201B)
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