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MMI PERMIT APPLICATION BUILDING / MECHANICAL! PLUMBING I SIGN / SPRINKLER! DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1 '7)7 lam'I i b r) I VI%t PROPERTY TAX#: f7C?) T6X.- LEGAL for new construction: Short Plat/subdivision tv..t.� `1 n 6j Lot No. (attach copy of long legal descriptionf l 0 t t I I I. 2 CONTACT INFORMATION 11 OWNER NAME: l Y1� I(— t- `W 5` ol Lety ENANT BUSINESS NAME(commercial): (. /l - OWNER MAILING ADDRESS: STREET 1 CD 2 v0 U I /4{0 }I V CA CITY L.r STATE WA ZIP `Cl a o OWNER PHONE: /,, -/ �j ( - , 1 4 OWNER EMAIL• >r (j V•` 47j ` n ex-08C CONTRACTOR NAME: " - C J€ L' -t',2 trn (_A.t c A CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: DOWNER 0 CONTRACTOR OTHER(Please Specify) `A ( , ' ...--(l f. CONTACT NAME: ( _� 4---i,•� Lj(�j>�n-Zy� k_ , CONTACT PHONE: 4-1 E- 344�-C1�L3-2 [ (/t�Y��iI L- 7) )1 I VS CONTACT EMAIL:Q�j y�ZA ULtJ(ilC`) 1� l� 1 4.V IotcAM1 BUILDING INFORMATION Existing Use of Building: 12"'/ Contract Price of Work: $ ` I 0 VDI,C Proposed Use of Building: - f t� Heat Source: ❑Gas E ctric OO r BUILDING USE'SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Ac ructure Type of Project: ❑New 2addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: r C d Y Ifoo G' i Dn — 14-M4-�r"i.ms -9 o1.c ka p lt16 et.idfcc� LN-trem r! U .L, al�l�l 1 l Cis l L_�_. ASSOCIATED BUILDING PERMIT#(if applicable MECHANICAL PERMIT APPLICATION - PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units /` .Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo • Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain ,--fink-Utility,laundry,mop i Exhaust Fans(Residential) Commercial Ventilatior Floor Drain - Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater tInterceptor-Grease / Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log _____._..--- Roof Drains Water Heater SPRINKLER/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads 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 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 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, and I ly with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only /L '/' U' €., t (� PERM C ‘ C/- O\ l /Authorized gent S re '/M- - kt-_ . Date (Revised 10/1012018) y Z