|
- PERMIT APPLICATION
<br /> BUILDING / MECHANICAL/ 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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue,or,Bllack Ink,Oiiik,Please) 3 ..�... . `. PROJECT 5ITE:IIIIP®RMA'I'iOPL�.n., g ;�` , .$ . n)�.i ,. t,„ ,r..y , ':
<br /> PROJECT SITE ADDRESS: v-7-~`( A (d't1*h OC, so PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTAcTINFORM.ATI01+1. . .,
<br /> i t 4
<br /> ...:2.... < . ,e. 7.1,.xa .x .. i1 hit. .., s, _.xt ,v .. ...:. 3. ..
<br /> OWNER NAME: 3 S'7u TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 3z.r2- O 5 `1� \ PO
<br /> o
<br /> CITY '61.-4140-3 U Y , STATE tA/ ZIP qp
<br /> OWNER PHONE: e0^ 22 Li 277 OWNER EMAIL: I'M 5 i NSPce.j Q??q @' 4 .co'l✓1
<br /> CONTRACTOR NAME: N T4A 6300 dJ'O C2iST•
<br /> 2T' t�?"7 ' pjt�2'L,r-i 4:45-TO#J t3 c.v b
<br /> CONTRACTOR ADDRESS: sTREEr�',✓� � /7 �.,,� y ��/��,,/�
<br /> CITY goalt cy--1 STATE LAN/5174 ZIP
<br /> CONTRACTOR PHONE: ace 0 LP I® 06.4C- CONTRACTOR EMAIL: 4:40,..) a NOrZ1-t---()'J1\110 ea04A6-6.eA) $/JCT.
<br /> CONTRACTOR LICENSE#(REQUIRED): !0d 64 L 1 DlM CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C( 5* ,I '07/
<br /> PRIMARY CONTACT: OWNER 'Pi CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 360-(p ID 00:6.)
<br /> SOYA-C.-ea- CONTACT EMAIL:
<br /> (dltl'►J, M312:1740ou"/0eotNST+zV-710`)' .ver
<br /> ;, _ ..,, .ti BUILDING 1,N O1 MA :1 N '.. . ._. ,glE, rNMM.. W
<br /> Existing Use of Building: t/rr(1- Contract Price of Work:$ ce)6 2• 6 5--
<br /> Proposed
<br /> Proposed Use of Building: i— 3 t-—-1-o G Heat Source: ❑Gas Ij2rElectric ❑Other
<br /> BUILDING USE: ❑SFR Eziownhouse 0 Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: LI New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> 619)4 IrZ, V Ve-k.- Pt-CK. 12-P t L)^Z- V\i4A-(
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> r ., :MEBHAMIGAL PERMIT APPLICATIONi, .... .<: .,., rPL MBING J'ERtM1 `.AI'P"LIGAIIOti ... .
<br /> Fixture Fixture Fixture Fixture
<br /> Count
<br /> 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 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 SYS'T'EM .., 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 five 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 /> 0 . • 0 ( to 1 i ' . PERMIT#,3 lg05^0)
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
<br />
|