|
ilip
<br /> PERMIT APPLICATION
<br /> BUILDING /MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> II
<br /> PROJECT SITE ADDRES: qttig, L®e..G.L . 6+ iUv-,....,Xt PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: Zu.ks,„At. t(ex t f.� TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET '- 0P01;,-,,,,, �t ' t i'?
<br /> �?iK kr l e CITY 7 ! .� .. 1 STATE (.'L) ZIP 9 g,�0 6
<br /> OWNER PHONE: bt XI 3 -4 ( �_M"'—_—V OWNER EMAIL:bceyi40.,C1r) Nj G,OC"
<br /> CONTRACTOR NAME ---S6 L.", (., i I ,°...tAA.5 I if T PC t
<br /> A Vai ing„,_
<br /> CONTRACTOR ADDRESS: STREET f.). 0 g© V', I
<br /> CITY ---�9 5� V� w�STATE ZIP ��'L{
<br /> CONTRACTOR PHONE: 3360 -795 So CONTRACTOR EMAIL: R 5 • p
<br /> a i(!N; +.t,//�� a ko L_a CO
<br /> CONTRACTOR LICENSE#(REQUIRED): JPA 1 "0�4C�'rITY OF EVERETT BUSINESS LICENSE#REQC IRED)
<br /> :. .,.� .... . :: , . ,. . . . . ... :.fi .
<br /> PRIMARY CONTACT: 0 OWNER P.CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: j i CONTACT PHONE: 4„( x 5 Alo 93 pi-t
<br /> °L-"- ( ' (( : 40..(A.,_47 CONTACT EMAIL: Q. ""V"' 6 PCN: vii itf. L a btu
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: SI .. .,K,c6,.....“,' to•e...SatK tr;=T�ract Price of Work:$ 6. i e 4 451
<br /> Proposed Use of Building: _ 0 Heat Source: Gas ❑Electric 0Other
<br /> BUILDING USE: ❑SFR IiTownhouse jig Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial El Accessory Structure
<br /> Type of Project: ❑New DAddition ❑Remodel *Repair OT.I. ❑Sign ❑Sprinkler ❑Demolition El Change of Use
<br /> DESCRIPTION OF WORK: ^P(ON U.— et,(
<br /> ` .; _ C- ire_ GO0CeA ;
<br /> {
<br /> Seo...\ 4 rt,r-,.% r- .t, ' �. i r e_f t a.t:.2., r�o..��.a. w ,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): �L.,:i lf?ej,C le_ 0, 1k '''4 i^it SocC g
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<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) a. Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer s Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher 3 Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain a, 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 j6 Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other:
<br /> Chemical or Water 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
<br /> made,and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> ( 5 Not/J-Oi ater P
<br /> Owner/Au ized Agent Signature Da (Revised 10/10/2018)
<br /> 'oL�... (A.).t t Co,044
<br />
|