|
NM PERMIT APPLICATIO
<br /> 1112
<br /> BUILDINECHANICAL/ PLUMBING /SIG14RINKLER/ 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> a(Bl u+e er Black Ink Only Pleasel,. ...z ' PROJECT SITE;INFORMATIIO r , ,.. ., xw.gig .3,.
<br /> PROJECT SITE ADDRESS: 221 I r /(fc,---,,y/( ..-/e-,.4, / f t)"v PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> +CONTAS'TaNFORMIIATjION. ,
<br /> OWNER NAME: #0"pc-© TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 2...z-is- 11. ,rt-,-//' t','_-c.,,4'A.,r A cm
<br /> ,g1)
<br /> CITYet--- , STATE 4,...6/7/4 ZIP
<br /> OWNER PHONE: 4/, .(-- Z ,/ OWNER EMAIL:
<br /> CONTRACTOR NAME: ,SfiG ya,/t:ir /./?/)06yl, , f
<br /> CONTRACTOR ADDRESS: STREET 2,/ ,� 7/O ^ /r/
<br /> /z/� 1 ,...4'(../E: /1",/,:r77
<br /> CITY .fes 0 6 GI... jj, //!r- STATE 64),* ZIP ,d v 72.,
<br /> CONTRACTOR PHONE: (-0J-r LAK3 ..-1)L G 4 CONTRACTOR EMAIL: i.C: i 1 7, `��� -.(74:9 t'�Ick-7--
<br /> fie., Z___4-,,,,,e„s ,.CONTRACTOR LICENSE#(REQUIRED): A J--3-7- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): V
<br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> /4/ D UA CONTACT EMAIL:/44/./40 .on -4 or'-s2� Oci
<br /> .,<. . BUILDING N ORMA 'ION j. ,k., E.E»E
<br /> Existing Use of Building: Wetre_/ 7",j, t7 F c e Contract Price of Work:$ ') / 7 rf-`Z I D
<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 ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: Q V G4A.I/ ,bra 717',1 ra C r7e. W PTA n ,G us -C ./1,. 1", ,..r..;441/4.../4 ",-`t 7
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> . .. MECHANICAL PEERM1tAPPLICATION. ,, r PLU VISIING,PERMIT A1'PLIIC/01.100N1 .1 .
<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 /> ,; S�PRINKLSIfj SUPPRESSION SYS TEM 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.1 am 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 /> PERMIT l9 1. 6_ to2
<br /> Owner/Authorized Agent Sig e /� Date (Revised 4/15/2019)
<br /> i
<br /> Z
<br />
|