Laserfiche WebLink
OLT 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 1 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: Q C (Cc At 1-11 A vr'_ ),Cor:c-4 f #' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: J 0\t- c. Ands„cc, TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: C`12 1 3,SC� 1-l"(,00 OWNER EMAIL: k<t c� <br /> J c L k--/ 1 ct gI.S'GJ CS cri.4. c,‘r.(_ . CC .� <br /> CONTRACTOR NAME: A,��c).n10_ -�do <br /> CONTRACTOR ADDRESS: STREET /Q 2 C'9 1.5-1 .4-4, S4- 5 -6- <br /> CITY <br /> CITY t-to/t (c, STATE _A ZIP q Q2 i-Z <br /> CONTRACTOR PHONE: (''ZS) +SO -c.t3,3 CONTRACTOR EMAIL: lc.vMsdr ,,c c., ,5,,-,V, .Ce^'� <br /> CONTRACTOR LICENSE#(REQUIRED): l�\t'l 5 D.5 P6/0 13 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): FYI 2.1 a,5�- <br /> PRIMARY CONTACT: g]OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAM '4 ° 1'"6-k'c- CONTACT PHONE: '1.2,5 f5-0 <br /> CONTACT EMAIL: / a M S (A.(y u,c,(,t c,),,: d-CO eVi <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ElElectric DOther <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ?Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ONew ❑Addition (Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> __-C'S C " (.t 0 ,'c-w co 0 S kei C D c_(r„ -r- - ✓c (?to Ailc_s <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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) Shower,Tub,or Combo <br /> Boiler Gas Range I Clothes Washer Sink-Commercial3-com <br /> ( p,prep,floor) <br /> I 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 Ventilation 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/SUPPRESSION 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 the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> C ( '0-3 -0U( <br /> Owner/Authorized Agent Sign ture Date (Revised 10/10/2018) <br />