|
IIII PERMIT APPLICATION
<br /> BUILD= 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 1 www.everettwa.gov/permits
<br /> (Blue or Mack Iik<:0my Please),.) „PROJECT SITE INP'PRMATIQI!I. , .., . ,. E.., ... ... ., ..,
<br /> PROJECT SITE ADDRESS: rd CA S( PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> .,. .: ,. ONTACT1:400RMAT>IOt1_. .. of _ .
<br /> OWNER NAME: Ccxr01 13ra A 1 Q.Y TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 607- 73,rd k,,,e_, V G t)
<br /> ue,('r --\-‘K_ CITY (.4 0, \ STATE ZIP / / f
<br /> 1
<br /> OWNER PHONE: OWNER EMAIL: F_
<br /> CONTRACTOR NAME: Z7 q( r, 'C' akyo ( n
<br /> CONTRACTOR ADDRESS: STREET /���3 C./ / r-r'-� �V c 1 i. J 4--
<br /> CITY
<br /> 4 �// V\,ci j ir\ \o C� [a<ickc e STATE ��' , ZIP / g4 / 3
<br /> CONTRACTOR PHONE: W�. TRACTOR EMAIL: `t In Q 0 0' -- _sqr lb
<br /> CONTRACTOR LICENSE#(REQUI- D): )1 Q— , C I$I CITY OF EVERETT BUSINESS LICENSE#(RE i•'.-ED): Co
<br /> PRIMARY CONTACT: ❑OWNER 5I CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 0 J Q a ( z t 9 /'L3
<br /> ArveiA C \I oi..v\`c-e--- CONTACT EMAIL:
<br /> c
<br /> IN
<br /> ��... . , .` ..., � �� .. .. :. . .... . ........ . _R?1���-0. ..OjI#0,.,I1fIAT101� .. ,.., �, ,... .. . . .-. ., .. ,
<br /> R -._
<br /> Existing Use of Building: Contract Price of Work: ; ca d. (5-4-D
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑A sory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel %Repair ❑T.I. ❑Sign ❑Sprinkler iemo'' Change of Use
<br /> DESCRIPTION�� OF WORK: l /� `�
<br /> 1` ,10 U\"C CL G e—`C \NI\ e-- k,-4-0.i` IA V�S e 4\ ` O9' \\N-'e ‘b l9 S e--
<br /> V s p c \\N
<br /> ASSOCIATED BUILDING PERMIT#(ifpplicable):
<br /> MECHANICAL R00,A.I,APPLACATIONtgb10 .;; PLUMBI G PERMIT;,AP,000 TION;: .. ,.m ,
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> A/C—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 /> -- SPRINKLER/_SUPPRESSION SYSTS:J 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.-ing 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,
<br /> and I comply wit th- de Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PE
<br /> .Owner ` ' Date (Revised 4/15/2019)
<br />
|