|
IME PER CATION
<br /> 1112
<br /> BUILDING =E:CHANICAL PLUMBI /SIGN OMINKLER/ 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 /> (Bine:or wac! Ink. rtly Please) PROJECT;51TE#NF RM ► ,IQi! .,..
<br /> �� t. Say lex w /is 207i/ PROPERTY TAX#:
<br /> PROJECT SITE ADDRESS: �t
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFO1 MATIIOtV
<br /> OWNER NAME: V Oe Cer1nt, ` TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET $L-1 to E X4v1 er hl�t�.lr�
<br /> CITY .-4i- STATE wV9 ZIP I c(-W1(
<br /> OWNER PHONE: OWNER EMAIL:
<br /> �_�. ,.�s--.�, �,:x,�..,� _ �•„� -,����. �,.�.,.„,.��,�� x:�,,, », „y rR ,,:.<,,,.�n,,.�,�•,.. �„�,,,....•� �,�r�, �� .-a-:,�,
<br /> CONTRACTOR NAME: W t Atli( 'I V nn b r C.a i
<br /> CONTRACTOR ADDRESS: STREET ( J ��, Q,r- . 14e39).03 4 L°
<br /> CITY Let. ,�� e.AW STATE LAA4 ZIP q$Z.
<br /> CONTRACTOR PHONE:t4 4• LI I •3q(0 r CONTRACTOR EMAIL: w(4i14rroJ(A) IOUs'Pldr% ;r1_• C01►'1
<br /> CONTRACTOR LICENSE#(REQUIRED):CC. v.)Al1'WC Og5iI~4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):{659(0
<br /> � R �. � ��v �. .aE. _ �W_ hu mss__..._.___..,•»„ N»:,
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 1 OTHER(Please Specify) t-+5 & r �•-�
<br /> CONTACT NAME: CONTACT PHONE: LJ 7,,,5- q . '7 Li
<br /> Cvve I S c7rOves CONTACT EMAIL:
<br /> � .DI11a.l<1 �1�11Tt171 .
<br /> Existing Use of Building: 12. ; y1•• ,t Contract Price of Work:$ ;► 00 O
<br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other
<br /> BUILDING USE: SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New DAddition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> t ,
<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) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher f Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain 1 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 /> SP INKLER/_SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System No.of Heads.
<br /> ACKNOWLEDGEMENT:l 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT
<br /> � �-- 7/1hI '16 1-**-1 ()CC°
<br /> Revised 4/15/2019
<br /> Owner/Authorized Agent Signature Date ( )
<br />
|