12902 19TH AVE SE GENUINE SMILE DENTISTRY 2021-02-23

aim12 PERMIT APPLICATIO* BUILDING MECHANICAL/ PLUMBING /SIGN PRINKLER/ 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: / j'0 if /30'4,4 C-vc,-,,e =c PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION 11 OWNER NAME: Pr & e. 6.;aiti. TENANT BUSINESS NAME(Commercial): 0,- , er�JF 6 41 — ei OWNER MAILING ADDRESS: STREET /Z 9 0 L Lp L '/'— �U 4'r*e /,L le,--)P'a SU i>l n [� CITY twee 7'T' (� ( STATE ��p�j� ZIP .I�52,! a 13 �1 OWNER PHONE: OWNER EMAIL: N 1, vi 4 L01 1I3 9i5.6 Y�P-4 VV`�ol, CONTRACTOR NAME: **7-/e Rh ,tv� (.47? CONTRACTOR ADDRESS: STREET 95 31 tier / ' ' S4-' CITY k'I. I(Apt) STATE Z.:.ia 41 / ZIP Y Sfif CONTRACTOR PHONE: 4/25 59/' 9 P 9 c CONTRACTOR EMAIL: //ASeP.ti.V -/k t "oL SD&Co - C d 3A„ CONTRACTOR LICENSE#(REQUIRED): U$o10* G) .5.. A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Sl Z q 6 PRIMARY CONTACT: 0 OWNER PrCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: - (� CONTACT PHONE: '/2 ' 6 9/ 9J gg `; asu;.t RO4),f0-. CONTACT EMAIL: u .ti...lit 71/L e. f h'?fi 5 Ls. C o . c v,t,%—_. BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ Z, c'26 • Proposed Use of Building: n(4 tea/ Heat Source: ❑Gas ❑.,..Electric ❑Other ❑ ,rJ BUILDING USE: ❑SFR ❑Townhouse Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair jar.i. ❑Sign ❑Sprinkler ❑Demolition OChange of Use DESCRIPTION OF WORK: / p / /11—�-� :"Th L,i6- - / (VA, c) ,a' � ) 4 s:1 p al ' . i ASSOCIATED BUILDING PERMIT#(if applicable): 4 L r)'-D 2-ti 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 z 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 Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior / Floor Drain Z Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: I Z Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains i Water Heater SPRINKLER I 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only J. ---S .' (..----"" / / PERMITCrc, k 030 Owner/Authorized Agent Signature // Date (Revised 4/15/2019)