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11111 PERMIT APPLICATI111
<br /> BUILDIP— MECHANICAL/ PLUMBING /SIC PRINKLER/ DEMOLITION
<br /> E V E R E T TCITY 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 /> (Billie.plr I iii kink Ly#44i4i l. ... PRO. :04-1*,FOR{ Att.0I .. , ....F..,
<br /> PROJECT SITE ADDRESS: l 22 12 l .A¢S -V1U+ S`c-)t�I e(Ai" 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: (tt554 f � , � TENANT BUSINESS NAME(Commercial): AAA() ft C / 1 rv�f-
<br /> OWNER MAILING ADDRESS: sTREETPD (2,cw�-7'
<br /> CITY D` /V4 STATE IN
<br /> / ZIP (782)`l
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<br /> OWNER PHONE:4425 94 5-6, c. OWNER EMAIL Kar-(2 kP 7/3'141 l , ( y2---,
<br /> CONTRACTOR NAME: "I►, 01(f J, , I ' �'
<br /> CONTRACTOR ADDRESS: STREET %,„... N ` Y
<br /> CITY - STATE ,
<br /> CONTRACTOR PHONE. y.- , = - " CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): ! _ V CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
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<br /> PRIMARY CONTACT:xltl OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: , 4 Z -- -(I `(—c /57
<br /> VV`A(SSA, \K\s\rP ,.y CONTACT EMAIL: e Ur F- -sp `tro v- c , cBUILDING INFORMATION . °. . {
<br /> Existing Use of Building: Contract Price of Work:$ Li/S C
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: £' ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel )epair ❑T.I. ❑Sign ❑Sprrinin�^kler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: �e L - L
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> W.,MECHANICAL PERMIT APP,LIEATION., .:PLUMBING PERMfl APP'UCATION .
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> NC–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 Ventilation 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 /> -,. APRINKLERASUPPRESSION: STEM, {,, 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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made,
<br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> 1 . 52�- i< R(►9l( � PSctoc6 —4n
<br /> 1
<br /> , cr/ uthorized Agent Signature Date (Revised 4/15/2019) 6.)„...
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