|
112 PERMIT APPLICATION
<br /> BUILDING I MECHANICAL I PLUMBING /SIGN/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 E FAX 425.257-8857 i(E)everetteps©everettwa.gov i www.everettwa.gov/permits
<br /> Blue or Black Ink Only Please PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS. 2:32,,.0 t:Jv t i t r4v�; PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> rwx *. f2A 1E
<br /> OWNER NAME: � r t.�.�� NANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET Z-3-to cwt` A V ,
<br /> cnY EU Rea— STATE "e ZIP 1 ZC ZO
<br /> OWNER PHONE: OWNER EMAiL: i
<br /> CONTRACTOR NAME: Ev/��6Z t .:>?k,Ai 9 : Fj-(r
<br /> CONTRACTOR ADDRESS: STREET 2,/z‘) (PA}
<br /> CRY C V(;%t21a t STATE LOA-r ZIP V;7.--01
<br /> CONTRACTOR PHONE: 02C-) '7 VS z.- 3 11`-f CONTRACTOR EMAIL: Ko a, !J a SSI" at L.I(tt,)
<br /> CONTRACTOR LICENSE#(REQUIRED): 6U EfZ,PjsSUZZOT— CITY OF EVERETT BUSINESS LICENSEi!(REQUIREO):00'7 9 cS
<br /> PRIMARY CONTACT: ©OWNER SONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ((f Z5-) 50g'- 6.,7z,7,,,
<br /> G./`,f 511 CONTACT EMAIL: ,-rn,tr 5 Sti4t41,1, LIDh
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ ,j 1 PO r
<br /> Proposed Use of Building: Heat Source: al,Qas DElectric ©Other
<br /> BUILDING USE: ©SFR DTownhouse ODuplex ❑ADU OMuiti-Family-#Units:� MCommerciai ❑Accessary Structure
<br /> Type of Project: ©New ❑Addition DRemodel ©Repair ❑T.I. DSign ❑Sprinkler ❑Demolition EIChange of Use
<br /> DESCRIPTION OF WORK: R„?(,,,,,,-. (3 6A5 u. tct
<br /> ASSOCIATED BUILDING PERMIT# if a.•likable:
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> FixtureList of Fixtures Fixture List of Fixtures Fixture List of Fixtures Fixture List of Fixtures
<br /> count count Count Count
<br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boller 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 /> 3 Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System I 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 the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> [../..1., - 4,,,,,,z
<br /> / -,-2) PERMIT# ,C)D l 01
<br /> Owner/Authorized Agent Signature Date {Revised 10/10/2018)
<br />
|