|
PERMIT APPLICATIOIA��
<br /> MI
<br /> BUILDIN CHANICAL/ PLUMBING/SIGN 1 'RINKLER/ 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,or 3lac I4,40,*,PleaseJ�: l�.,.. ... PRR1.JECT SJTEiNFoit AT. O I, .,,., .. $` ..... v,,, F-3,s . . .. ...., , v., ,,
<br /> PROJECT SITE ADDRESS: 1 1( 7 NP v i+ Ave PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> E t i ;. yp[ O X ^K c
<br /> T A 1
<br /> OWNER NAME: I/00 (10 j 0G 1( 1-Het,'i4 459Eti r L Z.C, TENANT BUSINESS NAME(Commercial): vik tiv;i,24i q LL(. :,A Sari
<br /> OWNER MAILING ADDRESS: STREET SA S I —3 kk
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> ., ._' . , .tea-.._ ._ _.._... _..,.�... .• .. . .
<br /> CONTRACTOR NAME: P4 kis plvcvi AA, GLC
<br /> CONTRACTOR ADDRESS: STREET ['3\ 2.. - �'s-i'k. Q
<br /> CITY Ar) !!!!1 h, STATE "WI\ ZIP 01�� 23
<br /> CONTRACTOR PHONE: G�'�, ? O. (CONTRACTOR EMAIL: paYkceilil yr,b11^+)0.9),, ,1, vyYl.
<br /> CONTRACTOR LICENSE#(REQUIREE A -1<S 171- 4—(0 0 N0 e
<br /> /ERETT BUSINESS LICENSE#(REQUIRED):4-7
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:i/ 1 i� CONTACT PHONE: 47,5- ..j(67 0 „:� J
<br /> �mu{ iv eel1ovIs Co)3(05'O3e �� CONTACT EMAIL:?Irks /t4"6,5Go"sett 1,c)/.4-'.
<br /> BNII:DI)N 1 ORM NICO'k. ,s ,, r` .,._.
<br /> Existing Use of Building: Contract Price of Work:$ Z 554-•9
<br /> Proposed Use of Building: Heat Source: OGas 0 Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑ emodel 0 Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: I. 11 Z1` v 4 ot ,reo se 3-r e_ t,,,,K r w ,X jc1- res-1-w ret - 1-.
<br /> •
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> !MECHANICAL PERMIT APPLICATION.,,,. „ a,.PL1.MBIN0 PE tMMIT, 1PPLICATION".. ,,x , <
<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 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 /> .,..,,c. SPRINKLER 1.S IPPRESSION SYSTEM_n Sewage Ejector or Sump Pump I Other: lak Atli tlj.�
<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 author' -d under any circumstance.l am the owner,or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and 1 comply with the State Co - tors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> 1/ PERM z _ (D
<br /> Do(^ c(
<br /> Owner/Authorized Agent Signature D e (Revised 4/15/2019)
<br />
|