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112 PERMIT APPLICATIO <br /> BUILDtN ECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES. <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 f FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION (-s 1 <br /> PROJECT SITE ADDRESS: 824 W. (..A611.10 Rd. BLS 'B' PROPERTY TAX#: O6342.100:00 70.0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CASs -t rr,�ar+rr Af oRDA(3 AUAI►'�. APARToiet.r, <br /> 41ou, v4 TENANT BUSINESS NAM ••• , <br /> OWNER MAILING ADDRESS: STREET 7-22.3 1 12414 A uE N.E, . +e I o Z <br /> cm 5 E 1-L.E N/u E STATE WA ZIP q$00 ut <br /> OWNER PHONE: 14 Z5 G 3 3- 0 443 OWNER EMAIL: <br /> CONTRACTOR NAME: LoyAL MECWANICAL/ Pic. t ao'. Pror4EER f1.44.446,146 dH q. <br /> CONTRACTOR ADDRESS: STREET 7y0a NA)! 804.4 $4. -4 286 <br /> an, Se T7'L.£ <br /> , STATE WA vP98t17-4YY9 <br /> CONTRACTOR PHONE: Zd& 7898OZq CONTRACTOR EMAIL: 1:04QA "Z pioneer hitutilolnq.kiZ. <br /> CONTRACTOR LICENSE#(REQUIRED): L o'/AL MI 14 1 O K CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): H 1"J 17 <br /> PRIMARY CONTACT: ❑OWNER in CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: PIotees PLwvIerNCr u N•}q. CONTACT PHONE: iob 510 •3U7 <br /> PJ R IA►D L. )--At2SC&) CONTACT EMAIL: ` <br /> brran ) pionet�rflwtilbinq.br2 <br /> BUILDING INFORMATION <br /> Existing Use of Building: IS- eV <br /> Contract Price of Work:$ 5OCC — <br /> Proposed Use of Building: EL-IL Heat Source: ❑Gas MElectric DOther <br /> BUILDING USE: DSFR OTownhouse ❑Duplex OADU RIMulti-Family-#Units: ❑Commercial OAccessory Structure <br /> Type of Project: [New DAddition DRemodel ri;lRepair OT.I. OSign OSprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: REPLACE E7C r5'ztNeN S M OKE JwA rE(t UArv►AGM) PL.t vv liJ FrX-ciAra 6 ANC. <br /> UiATtre_ kteirrEAS t,,otTH NEW. LAA1)T6 2' ( d BID <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Fbcture Fixture Fixture <br /> Count coupe List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) '2 Shower,Tub,or Combo <br /> Boiler Gas Range 7 Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> ` <br /> Clothes Dryer Heat Pump&Ductless Z. Dishwasher 4, Sink-Residential(kitchen,bath,bar) _ <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilator Floor Drain Z, 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 2, Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other. <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I No.of Heads 10A TerrAl. 14 I <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and coneot.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 /> 3 1 J � <br /> City of Everett Official Use Only <br /> b,„:-.,A, v).,,,,,,) Rl PERMIT /� DOI 01 <br /> 2 <br /> Owner/Authorized Agent Signature Date (Revised 10/10/1018) <br />