Laserfiche WebLink
PERMIT APPLICATIO <br /> BUILDING MECHANICAL/PLUMBING/SIGN NPRINKLER/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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ',ZCI tG S-�.c�, <*• PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION (Nk1Z-Lt—Csamz%Ceil-S <br /> OWNER NAME: VAa,��L IQ� Lam` ,,� TENANT BUSINESS NAME(Commercial): c9-CA G-r .,aCly <br /> OWNER MAILING ADDRESS: STREET 2q I 5 � S{- 6iVCG41 /(k'tw r <br /> CITY (z V e brZ e' STATE W c , ZIP 5 pj`Q I <br /> OWNER PHONE: 2-0C,- to -ZS 9'8 OWNER EMAIL: v+n�;�tC,r^ ltsC�- co i^ k <br /> CONTRACTOR NAME: jo �S Vw tit Z) <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE <br /> #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: Qs.OWNER — ONTRACTOR ITHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> ep toptiAK CONTACT EMAIL: r <br /> BUILDING INFORMATION <br /> Existing Use of Building: I(/(f;{7t/ /,((Nd Q }�$,Srll Contract Price of Work:$_ C0[ 0 o <br /> Proposed Use of Building: r` f Heat Source: ❑Gas DElectric Oother <br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: 13ommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair 'f.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> CP- <br /> A00 STIa - c,��t�. zC� Ir4�C�s5 SZO6" dF t�v �O Ncr • S\-otrwel\ S i ' nal Vo-rhe_ <br /> \004114, <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 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 /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I 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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PER # <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />