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MMI PERMIT APPLICATIO� <br /> BUILDING ECHANICAL I PLUMBING / SIGN I'SPRINKLER I 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: \ ("O1..\ /// 4va PROPERTY TAX#: 002-k? \i-t 11j 0\\C ) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: - \>a' TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET � .a\ C,6 $- \A.v'c_ <br /> ` <br /> CITY �1\\‘..� CI C�STATE ZIP Q <br /> OWNER PHONE: ,,, -1\9,,,\\"O OWNER"`�11 EMAIL: <br /> CONTRACTOR NAME: cA\c:_sa.,(4\ ,_ C,.\\-/ �\��J._\�,.,� <br /> CONTRACTOR ADDRESS: STREET \CIS \\ IS- \-+� <br /> \�t\ , \\ CITY Q 9�\ STATE q°G.: A ZIP CONTRACTOR PHONE: �jF, ( tv j \,nCj CONTRACTOR EMAIL: \I\Ekc,A. . ( .�/�l,`,�\� \� kuk• <br /> �� <br /> CONTRACTOR LICENSE#(REQUIRED) Q'tT(..?�,pL\�� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): u, ��\ <br /> PRIMARY CONTACT: 0 OWNER Iti.CONTRACTOR 0 OTHER(Please Specify) 1�1 2�T �c 11 <br /> CONTACT NAME: ,wiga � 1- CONTACT PHONE: ��� \�7 � 1� <br /> [� <br /> "' ci\w:_%SL_/c CONTACT EMAIL: Iyv\,\L•C \C Gk.� )' "k IDtt‘.*\V\ 1, <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ ( C—) <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> BUILDING USE: >tSFR ❑Townhouse El Duplex DADU ❑Multi-Family-#Units: OCommercial DAccessory Structure <br /> Type of Project: El New DAddition El Remodel ` .IRepair ❑T.l. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> W <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) j Shower,Tub,or Combo <br /> Boiler Gas Range I Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless 1 Dishwasher g Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain a, Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) ?i 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 I Water Heater <br /> SPRINKLER i SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads 1?j <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 gr-- ,g 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 authoriz und: 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 tate Contrac.rs L., 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ,., (0--3-\� PER \ D__ <br /> co <br /> l (Revised <br /> Own r/Aut I ed A. nt Signature Date 4/15/2019) <br />