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MEM PERMIT APPLICATI
<br /> BUILDIIIn
<br /> � MECHANICAL/ PLUMBING/SIGIPRINKLER/ DEMOLITION
<br /> EVERETTCITY 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 ar Black Ink Only Please); " ` .. ` PRO ACI SITE INFORMATIOltt .'. ,:,..._> ,.. ,..,. „ . ., . ... . ...,.
<br /> PROJECT SITE ADDRESS: 3 i 7,5- Col��ki ,S TI'-$. T PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> , i ,.-: CONTAC' I rtiol*ATIQM, S.
<br /> OWNER NAME: .szS ri- t, 77S t—j..44.„.p‘,p TE merc,a : v3e.t eJKW,4--&LecQGrb..tp
<br /> OWNER MAILING ADDRESS: STREET t (,, ( (., 2c,,.C-,‘ -.J.c ii-Q N...e
<br /> CITY (!Z7" . Ii--
<br /> 1 STATE VV (It ZIP ( 2a)
<br /> OWNER PHONE: s - 6-44 S{ 1NER EMAIL:
<br /> p. ... ... n> s, ._.,..,_,.-.-oma • � Rro, , .. T
<br /> CONTRACTOR NAME: CT AA, 3 a h ,..�.S 94,7-u E@°A /'\..0_
<br /> CONTRACTOR ADDRESS: STREET -13 Oct Wel('Pt.o$,ti 6G4 its
<br /> CITY /to`f,!amu S a(, t(t_. STATE 00 ZIP 'J
<br /> CONTRACTOR PHONE: LI 2_5-- 3z/6~.s 3/ 7 CONTRACTOR EMAIL: V-L('( ad C.Lct(( Is yt , Co M
<br /> CONTRACTOR LICENSE#(REQUIRED): .61 -L.LC;t 00 _ CITY OF EVERETT BUSINESS LICENSE#(REQ AIRED): =$'�
<br /> was"�M, ..,.,,. -�-> :..a... ate•-., �,.,, _ _ �_m_,,..
<br /> PRIMARY CONTACT: 0 OWNER PI,CONTRACTOR 0 OTHER(Please Specify) FAO
<br /> CONTACT NAME: CONTACT PHONE: 4'Lj., 3L/, , 3 /7
<br /> V �.et 6-00 CONTACT EMAIL: tF ' 1
<br /> e�-°�' � � F rQ�-ll;s�. LO W\
<br /> ,,..,, <, " .. . ,� " .- , *70)NG�NEORMA't' ON - sx a 5.,, < < r L
<br /> Existing Use of Building: Contract Price of Wor $ 2-5-03 "'-
<br /> Proposed Use of Building: Heat Source: ❑Ga- ❑Electric ❑s 'er
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commerc' ❑Accessory Structure
<br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprink z ❑Dei.= ion ❑Change of Use
<br /> DESCRIPTION OF WORK: M ` o P-- W rert,l- C.--4d-vi-t..) C9'0" C,A_)-t,A) gera-p_i i,ii G- &treere-Snt 9S6
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): 15'7 el) i C✓t-ii O it Ci 1/4c0-1-eit - (pitt 0it- # .C4-YY+-e- k f
<br /> MECHANICAL;PERMIT APPLICATIONIN , ",- I .. .,_`PLUMBl1lIG I'ERM.I ',A'PLtCATION: G,.,. ._ ,
<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 /> SPRINKLER!-SUPPI ESSIONT SYSTEM '. ` Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System No.of Heads.
<br /> ACKNOWLEDGEMENT:t 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.lam 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 /> .. . F-7— 5--71 MVtoS . 0 .5
<br /> OwnVIA ri -. Ag, t Signature ' Date (Revised 4/15/2019) 1
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