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MIMI • 411
<br /> III
<br /> PERMIT APPLICATION
<br /> BUILDING I MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ 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 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 5(5. 6.;(5:' '"_, -^zX} = PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: bCJ(14'v;w Li k.) - ;' TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET /f s'z ! ✓6,, Z& k J COY
<br /> CITY t�-.,+✓C= cf'�2r,tn.' STATE €.{,1,,A,. ZIP r L0t..,J' .�
<br /> OWNER PHONE:; e-;i c S .-$c)°3 5j/ OWNER EMAIL:
<br /> CONTRACTOR NAME: 13,' ,;t i:A. :`•7' ,41- ,q/tti •;t.. i,&„,(-,F;E-,--__
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<br /> CONTRACTOR ADDRESS: STREET 7•..t 2.{ 0!4‘..,,,...-(/
<br /> s F r c,
<br /> CITY iM` ,( sr'I<;7'..t ' , STATE(G .. ZIP (CrS. tr I
<br /> CONTRACTOR PHONE: Cif`_c, ) /2.J 31 t 'CONTRACTOR EMAIL: hoc`=vt( ,:e y5 ii 1,_/c4 , 6..Cis/
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<br /> CONTRACTOR LICENSE#(REQUIRED):b'i.it ;;S G'2 "(_... CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ('f-• 7`-( L;
<br /> PRIMARY CONTACT: D OWNER CONTRACTOR D OTHER(Please Specify)
<br /> CONTACT NAME:, CONTACT PHONE: icy/ Lc()cK —07 Z z-
<br /> 1 CONTACT EMAIL:
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ , ‘. t ,
<br /> Proposed Use of Building: Heat Source: Gas DElectric ©Other
<br /> BUILDING USE: DSFR DTownhouse DDuplex DADU DMulti-Family-#Units: Commercial DAccessory Structure
<br /> Type of Project: ❑New DAddition DRemodel CJRepair DT.i. ❑Sign DSprinkler ❑Demolition DChange of Use
<br /> DESCRIPTION OF WORK: I4:c_`:�;1 t-it 4 C ?`2.-? '. t-^ V,,h..t C d.K.i F- I i.t C:� • ,:- i 1\.7 tt,.(,, , A ty,.',
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixruro Fixture Fixture
<br /> Count List of Fixtures coast 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,iloor)
<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 Ventiiatlor Floor Drain Toilet
<br /> Exhaust Hood pe I) (Not HeaUAC 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/O11 Water Service(behind meter)
<br /> Forced Air Systems Other, Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log -Z.- ' D ;NI,,,./--i-ki ffi 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 I 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,end 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.lam the owner,or l am authorized by the owner of this property to perform the work for which application Is made,
<br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> / °- tIA' '
<br /> PERMITlI0I J t I ,;j
<br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018)
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