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<br /> BUILDINACECHANICAL I PL UMB NG I SIGN TaP':1E4KLER I DEMO MON
<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 INFORMATI•N
<br /> PROJECT SITE ADDRESS: '2 ja ).\`S - Sic Cj 3 2u t t PROPERTY TAX#: 0 0 Cj rj �� Q (��t I SO
<br /> LEGAL for new construction: Short Plat/subdivision Lot No c'i t sv (attach copy of long legal description)
<br /> CONTACT INFORMATION!
<br /> OWNER NAME: Kam �h O hr 1,-e�lui Ce9YeA-Vti Cj J XkNT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET g,3C ,Z \A2 Ich k\',t, -'. �j q I
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<br /> crry`- icm A-vDy-l\\4> STATE}� ZIP ( h �,Cl )
<br /> OWNER PHONE:-(D (j r-D`Ct - \ c2;(, OWNER EMAIL: \__b ccr,-Nry-\CAY15 Z g e.; Ci A4 l0 Gl�,C.(?4v')
<br /> CONTRACTOR NAME: jaS(„Q. Cor, vtl an lX,� i)-1--,
<br /> CONTRACTOR ADDRESS: STREET E c�\ry\.e....,
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: Sc�.,YYl��/1 CONTRACTOR EMAIL: S CYY1 e
<br /> CONTRACTOR LICENSE#(REQUIRED): : }SC6-�;L 435361. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: AOWNER ❑ CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: o s I ci _ ( 0 0
<br /> �c .\.-`�,\,,,A,k, �wc rcIS- -3 e-t\- c`-- CONTACT EMAIL:
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work: $ 2.,"Ir) S C 5 O. —
<br /> Proposed Use of Building: Heat Source: OGas 'Electric DOther
<br /> BUILDING USE: ISFR ❑Townhouse ODuplex DADU DMulti-Family-#Units: ❑Commercial DAccessory Structure
<br /> Type of Project: ❑New DAddition VRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition DChange of Use
<br /> DESCRIPTION OF WORK: 1� ` 11 I
<br /> �A be r C C: ,v\ I 'C'zc c ,'\�-t y.:i e..., b zck r O O -m VJe., `5 Ll ram )i
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<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 I Dishwasher 5 Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> 'Z__ Exhaust Fans(Residential) Commercial Ventilation Floor Drain 2 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/ 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 /> PERMITS � 1 2.;.., 1(3n
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<br /> Owner/Authorized Agent Signature V Date (Revised 4/15/2019) )
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