|
II PERMIT APPLICATI011—
<br /> IL
<br /> BUILDINaECHANICAL/ PLUMBING/SIGN I' lioRINKLER/ 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 /> (Brae lrB: :ck InkQnly P[ee )„ `. . . ..,. .. PROJECT SITE INFORMATI3 N ...`.... . ,
<br /> PROJECT SITE ADDRESS: 4%4 BY'0A OI,4 " W ti/r vl t PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ,..•:,..:. ., . ,., :., ,.. _ rOQl+ITbCTt1*ORMATION .
<br /> OWNER NAME: fAY ajlle 114,14, FBUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: .-j+' t-e (a efrrtalr .,,F� i,, /
<br /> CONTRACTOR ADDRESS: STREET 7 C tA.r".. j/it N VI/ j(,( j t7r 'Z Y S
<br /> CITY D LuKf k STATE I4/ `4 ZIP 97.6 tl /
<br /> CONTRACTOR PHONE(/O') 79-4(7/ >7 y CONTRACTOR EMAIL: ((
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> ...... . ' .: .;1.iILD1'N� �NP0R1VIATIO0 �, .,
<br /> -Existing Use of Building: Contract Price of Work:$ 12Q)t X15(0, e
<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 0 Remodel ❑Repair ❑T.I. ❑Sign CI Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> 0/.11'0 0{' of cimiwita4( 'v di - Gtirup -ID bkehAA
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> N, MECHANIOAL PERMIT APPLICATIQ�1.., . .r. ., , PLti MBINVG,PERMIT APPLICATION �.,. , ,I
<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 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,/,,SUPPRESS,ION,SYSTEM 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.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 with t-e State Contractors La 18.27 RCW and 296.200A WAC.
<br /> 0/ City of Everett Official Use Only
<br /> �� /� PERMIT# 01 03
<br /> W.0 V . Afir " 'Owner/Authorized Agent Signature / Date (Revised 4/15/2019) h. j `
<br />
|