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NMI PERMIT APPLICATION
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<br /> BUILDING I MECHANICAL / PLUMBING /SIGN / SPRINKLER/ DEMOLITION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> WASHINGTON (Pj 425-267-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www:everettwa.govipernills
<br /> (Blue or Mick ink Only Please): : -, -: PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS; 129)[14 '"--br),/-' U41 I. A 4 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 /> , ___ _
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<br /> CONTRACTOR NAME: TO le/t6C -141 C.) i)L/(r)
<br /> CONTRACTOR ADDRESS: STREET It— 2cce:, 1 c 5 ;VI Pt- ..i./E-
<br /> ars( A' 6 vie re. 1 STATE t.1)6- ZIP
<br /> CONTRACTOR PHONE: Yir /12 5- 76? 79,-07 CONTRACTOR EMAIL4-1) fei eieCiriC 7 7/),y Ma"/, 6-c71L
<br /> CONTRACTOR LICENSE it(REQuiRED):*Tryi ate-et_t cl,R, 9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) CIV
<br /> PRIMARY CONTACT: 0 OWNER CI CONTRACTOR CI OTHER(Please Specify) * ' ce
<br /> 7 gOINTACT NAME: CONTACT PHONE. 4.-/ ..S .-/7c) 7 ci 0 1
<br /> N ......_ ...
<br /> J cr f v (YA(Lc+ e,P,S CONTACT EMAIL:4pl e_lex,:tr fc,--7 7 ON\ e 11/1 4 /ii,.• C C.177/--,
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<br /> • , • : :.:::•t:• : . :'• ••: '. :.'.:;,H .: .'. •:. ' -I:7 .: ;::'7-:•EiviOiNO!.iNiFoiintiiti:t100 ::: !''::I::.:: .:::.. :. .;.•,.: ,,:•• .':, , •;:‘
<br /> Existing Use of Building: Contract Price of Work:$
<br /> Proposed Use of Building: Heat Source: 1:1Gas I:Electric E3Other
<br /> BUILDING USE: DSFR 0 Townhouse I:Duplex DADU OMUlti-Family-#Units: EiCommercial DAccessorsr Structure
<br /> Type of Project; 0 New 1:Addition ORemodel CI Repair OTJ. DSign OSprinkler ODemolition 0 Change of Use
<br /> DESCRIPTION OF WORK: . .
<br /> tha 6\7\61,'" KAIiikA-1 -e (.t,) pil - \\ t, getevi-v- i-utii vwg 4 I ki
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION :.'.:: . - ...'''.: , .: PLUMRING:PORMIT APPLICATION
<br /> Fixture Fixture Fixture Fixture
<br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures
<br /> Count Count Count Count
<br /> _
<br /> A/C—Air Handling Units Gas Piping Backflow Preventer(inside Bldg) Shower,Tub,or Combo
<br /> Bolter Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&DuctIess Dishwasher Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventllatlor 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/011 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,DeviatiOna must first be authorized In writing from the
<br /> Building Official before being authorized under any circumstance.lam the owner,or!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 /> /-m City of Everett Official Use Only
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<br /> i-- m
<br /> - PERMIT#
<br /> Ir/1;1, clmi2,. 64411-1-el
<br /> r 1,... 1,./A.g41,-...1.,,t1 Annk,f gittrialitro Data (Revised 4/15/2019)
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