|
r
<br /> ® PERMIT APPLICATION ill IIII
<br /> LI illi
<br /> BUILDING / MECHANICAL I PLUMBING /SIGN /LPRINKLER/ 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 ar BlackInkOnly Please) PROJECT SITE,INFORMATION...... ,,
<br /> PROJECT SITE ADDRESS: ''
<br /> 3 t4 j (( l,` ',IQ PROPERTY TAX#: 00.`--f ri O .?0 i --F i 1 0 '
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ,. CONTACT IISi.FORMATION. .
<br /> I � -. . �,:�� � 1,
<br /> OWNER NAME: t�C.' ` E TENANT BUSINESS NAME(Commercial):, :-fit'"1-f ,3 ) '� , rte rilk
<br /> OWNER MAILING ADDRESS: STREET -ct f I I(I_ H, o or 0 e_,
<br /> LI
<br /> 1-t- STATE VA ZIP `
<br /> CITY C.:v�l'.- , Ct .> `F..f�%'
<br /> OWNER PHONE: 9-a° /-4S<;,:, . I 3 6 k_ OWNER EMAIL � t`,-- �s ��� (�i (z t E U itt �)(� 1.)<..\141°11 t
<br /> CONTRACTOR NAME: .I k;( i i Tact try -_`" ::_..",(IL v t c-c.,
<br /> CONTRACTOR ADDRESS: STREET 1:1-0.( ( I.\ck -c.„ 1. .„t
<br /> cm( v !E:`k E/T, ,' , STATE '‘,,,j Pt ZIP 9.VIA-L.
<br /> CONTRACTOR PHONE: L( 5`t -. j ( CONTRACTOR EMAIL: I( f ,., ;k`4 : �n� • i ( , t1,- \
<br /> Ire�.:' .�`�-•^ 1 '�•
<br /> CONTRACTOR LICENSE#(REQUIRED): C r:f:.. -e'l'1-5 (T 1' $"' i-1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (`Y-1 ff-; 5
<br /> PRIMARY CONTACT: ❑OWNER gl.,CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4:--L5 5-1 .. ` g`.
<br /> t
<br /> r�,� B rC,€ 1. ;CONTACT EMAIL: r e: � L-'(t'' t - ,,,°i rr.c- .(,:c yy\
<br /> Y3(
<br /> , B.OILDING INFORMATION
<br /> ‘::,,-.e
<br /> ` X
<br /> ,
<br /> Existing Use of Building: \i FJ ( .e {{ Ort.,:,- ., Contract Price of Work:$ FC'
<br /> Proposed Use of Building: d It.(c.e:('� Heat Source: IGas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: lACommercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I., ❑Sign OSprinkler ODemolition ❑Change of Use
<br /> DESCRIPTION OF WORK: j ` ' % \ (- ( " :C �jF� �C ) ( vCb(-(0 F " % {3 1.0 r°
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): !3 1 1 UT) _.) ' t
<br /> M,ECHANICALPERML•T APPLICATION, :PLUMBING;PERMIT APPLICATION
<br /> FixtureFixture Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures, Count List of Fixtures
<br /> A/C—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) 3 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 /> SPRINKLERt.FitiN*LEit't 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, MD6-0(0-1
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
<br /> (11;5
<br />
|