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NMI <br /> . PERMIT APPLICATION <br /> 12 <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN PRINKLER/ 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: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ..VN'eX e 100 f . TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET `�Y'N-Q,1i 'ti-e__-, <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 0 <br /> CITY .&.y,- v 11, STATE ,J ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: '(�\--)ert Qr!_2D.(A J-- crru`.. <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ''t <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ i'(gr'<5•& 10-(:%(71tp <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> BUILDING USE9FR ❑Townhouse 0 Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition CI Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:s,, pl., t,to.6 ups,} tft-S 60 +rnan., 6,,,oFE Cq ks1.vl•5 1/4))A-rcleL p peruvtile -Az) <br /> Ki tc 1r2 i/\, S, v v.`tv� •i Ll u' e.o,,v',,-. 2S42,13,-t,'it:S Li K e cv/L C--1 k,a t S ,-gtv -r l ?6 i,LVhio✓� <br /> 1�x.ru2C---S r /V.o4..1,E, S Ckx---6%-"--0 A/0 41eri/ MG! sN Su�,Q�=�n/ <br /> ASSOCIATED BUILDING PERMIT#(if/applicable): /3 <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 /> 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,floor) <br /> Clothes Dryer Heat Pump&Ductless I Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) R ' ratiGf\� Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) �ercial Ventilatior Floor Drain :3 Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease I 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/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 /> if(9 <br /> .. City of Everett Official Use Only <br /> PERMIT#^ ^ m^ J <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) II <br /> Z <br />