|
PERMIT APPLICATION
<br /> BUILuiNG/MECHANICAL I PLUMBING/SIGN/SPRI.—;LER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P.)425-257-8810 I FAX 425.257-8857 I(F)everettens eTaverenwa,gav I www.everettwa.gavlpermits
<br /> iiii
<br /> 'iiiiil
<br /> ( lie Or .r yq ot Q r /�✓'p..; �'Std V :- . . :a�X31 g
<br /> O ......H.....
<br /> PROJECT SITE ADDRESS: G $.�t PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description)
<br /> W ONIAT1oN
<br /> OWNER NAME: 00,41 1 I civ‘ (y.?tV - TENANT BUSINESS NAME(Commercial).
<br /> OWNER MAILING ADDRESS; STREET 21 2,g /fix 1 '"it" f 7 p�
<br /> Cow U Cf/C4-4' SFArE & EP —I #01 ..
<br /> OWNER PHONE:4'1 - 75 1 g-( OWNER EMAIL: , '''I19
<br /> �_ �_...... , ...� ...w. . ... . .
<br /> CONTRACTOR NAME /VI.A/)544 iest.AAM141
<br /> CONTRACTOR ADDRESS: STREET t'', t 1 -lr"k t
<br /> CITY I "yht" STATE (,1/ ,f ZIP 'iA9Z-7
<br /> CONTRACTOR PHONE:4 5 0{4 w+i,3 ' CONTRACTOR EMAIL: ^ "ftZrt _i 7ts,<{r<03.44
<br /> CONTRACTOR LICENSE#(REQUIRED}: it) 'g,,,>----5-- ..y CITY OF EVERETT BtUSINESSOCENSE s(REQUIRED):-5--7 I..�'
<br /> PRIMARY CONTACT: 44 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) .m..
<br /> CONTACT NAME: CONTACT PHONE: 4475- 7,5-1 "' c
<br /> ortoryo:/trk ^,ilk CONTACT EMAIL: 44
<br /> 0iIM0 ..
<br /> Existing Use of Building: Contract Price of Work:$ J t b Q
<br /> Proposed Use of Building: Heat Source: OGas VIElectric CDOther
<br /> BUILDING USE: DSFR OTown'use ©Duplex DADU ❑Multi-Family-#Units.„,,,,,,,,, DCommercial DAccessory Structure
<br /> Type of Pro)ect. DNew DAddition ( Remodel ❑Repair ❑T,I. Dsign DSprinkler DDemolition DChange of Use
<br /> DESCRIPTION OF WORK:
<br /> -VACrsC.e.- S 64.4. €E,e. VL. (11:4^-^-r- ',( ._
<br /> ASSOCIATED BUILDING PERMIT#(if applicablel: I I
<br /> MECHANICAL PRiiii."d .1 4 N f ,n.. $0M$ING. s .-3 I 7,
<br /> Ratans Ft,,,ie,°
<br /> List of Fixtures List of Fixtures Fixture' Lost of Fixtures lCounti'Ltre List Of Fixtures
<br /> Count gaunt Count Count
<br /> NC-- I Air Handling Units Gas Piping Backflow Preventer(Inside 81d41 Shower,Tub,or Combo
<br /> Border Gas Range :Clothes.Washer Sink-Commercial(T-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitehen,path,bar)
<br /> Duct System(Remodel) Refrjgeration Drinking Fountain k/U/14y,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Verdilaticr AGM°Drain Toilet
<br /> Exhaust Hood(Type I) (Not HeatrAC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Water Hester Interceptor-Grease Wastewater Piping Repair
<br /> Exhaust Hood tResidenIt$t Vii0VStove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air Systems „, Medical Gas Water Valves or Fixtures
<br /> Gas FrreptarerinsertLog r Roof brains 1 Waiter Heater
<br /> I - Y,�,„ sewage Ejector or Sump Pump Other.
<br /> Water oppression System No, o heads .
<br /> Chemical Suppression System No.of Heads .
<br /> ACKNOWLEDGEMENT:!have reviewed this applfcatlon and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with.
<br /> mouse federal,state,and local law.The granting of a permit only authorizes approved work and no dewiabone therefrom.Deviations must first be authorized in writing from the
<br /> Sending Official before being authohzed under any circumstance.I am the owner or tam authorized by the owner at this property to perform the wOrx far which application is made.
<br /> and I comply with the State Contractors Law 1527 RCW and 296.200A WAC.
<br /> City of Everett OiNatal Use Onty
<br /> PERMIT)JI 0 f:).\........,,
<br /> ./7".7 --- V 2-2-CI”
<br /> OwnerlAuthorized gtwture Date (Revised fOJlOf2d181
<br />
|