Laserfiche WebLink
mini , PERMIT APPLICATION <br /> ni, <br /> BUILDING I MECHANICAL/ PLUMBING /SIGN I SPRINKLER/ 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 I www.everettwa.gov/permits <br /> (D1ueotfackIkOnlyPteasi , PRQJSCT ITE,NFORMATIO*gm , . f` .. z <br /> PROJECT SITE ADDRESS: t t13 1 Al r pOrc RcA fk.\Q fe-t4 <br /> WR PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> M <br /> N' <br /> >�T FAVVIEM <br /> OWNER NAME: .\CTU " NI ,V1 C„.0 7a TENANT BUSINESS NAME(Commercial): 4., MI ryipm, <br /> OWNER MAILING ADDRESS: STREET l t 13 t A\r?or c IZ <br /> CITY P.klec e, k STATE vu A ZIP Gi&2O q <br /> OWNER PHONE: •, ti5 ISO 1.1"LI- OWNER EMAIL: La evert i @_ hotntc,u\ cor <br /> CONTRACTOR NAME: 0 UO fLer <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP `A <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: 1J \ --(p01 1 /3g03-1Z <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Q CQa <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: t <br /> p CONTACT PHONE: Lk is 15 O1 `I,.g Z4' <br /> eO C Ip J` l lV�(7 Z+'✓� CONTACT EMAIL: �...e11 ex ec e"t T @ j'Wnc t L covvl <br /> UILDING IPWORMATION g .ire.; . <br /> 00 <br /> Existing Use of Building: Contract Price of Work:$ $O 0 -- <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 'cei,,,,,,1 „- ce rfi 6.4 occlacow c -teamAKOtAdr <br /> ASSOCIATED BUILDING PERMIT#(if applicable): r 1/ 04• V"Is A I I bla. <br /> MECHANICAL PER I T A PLI�ATIQN, ,.,,. ,Kooly BI,NG;PERMIT`APPLICATXQM m .. <br /> Fixture Fixture Fixture Fixture a <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 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 /> SPRINKLER t•SUPPRESSIIO it SXSTE n 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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PER / # <br /> 0&122 1 zO1ak : L ,11�'r-'�► •i0 <br /> Owner/Aut'I. ed Agent Signature Date (Revised 4/15/2019) rj j <br /> /a <br />