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MMI PERMIT APPLICATION
<br /> BUILDINOECHANICAL/PLUMBING/SIGN!' I'rRINKLER/ DEMOLITION
<br /> EVERETT CITY OF EVERETT PERMIT SERVIG
<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 /> (jB!lue or,.slack lnk Only PIej se) , ., .._,_.,..PRoVga `,SITE NtFORMA IOs.z,. j. . .. „ .w ,n... , .r.o ,,..,,x .
<br /> PROJECT SITE ADDRESS: Ze/t7 1 ©A-y_c ,4 ,g PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME:,jfs.lGGl XS/A/&"-A621 TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 24oi
<br /> CITY /Z^t'"/`"&n STATE /j�/Q ZIP
<br /> OWNER PHONE: 2..S";_ lj Q OWNER EMAIL:
<br /> CONTRACTOR NAME: ,‹7A-7"
<br /> CONTRACTOR ADDRESS: STREET /3/ Az
<br /> CITY./ynC STATE R- ZIP 7i3 '7Z
<br /> CONTRACTOR PHONE: j.JZc 54E;-P2 3.-2_ CONTRACTOR EMAIL: --74-0 p
<br /> CONTRACTOR LICENSE#(REQUIRED):5T' - of f%/ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: L7Z5-_Sah9 _c92 3 a
<br /> CONTACT EMAIL: — �joz,..4
<br /> ,.. - .:: .,..,, ... .., _ ,..� .. ... ... ......:BOtLbiNkikPQ�IVI�I'�'�O1,. , . _ . .
<br /> INUMEUX
<br /> Existing Use of Building: 72.,‘" Contract Price of Work:$ Zi T SZU
<br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other
<br /> BUILDING USE:gaSFR ❑Townhouse 0 Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel Rkepair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ;TJX !,7 - :J' L-Z I Z..04(7E7L2
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> g., MECHANI043#ERM T_APPL(cATION. I. r. 1.1 BINGr PERMIT? P. .a 0:(0N'. ,.,.. , .
<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 Dishwasher Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatior 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/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 /> w ,SPRINKLER/S JPPRESSION 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 1 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 /> PERMI
<br /> Own orized Agent Signature Date (Revised /15/2019)
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