|
PERMIT APPLICATIO
<br /> BUILDIN& IIIIECHANICAL/ PLUMBING /SIG RINKLER/ 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue ilii ck.Ink Only Please) PR;fCT SITE,INFORMATION,.. ;.,::.-....... : ,.. ....
<br /> PROJECT SITE ADDRESS: 332 0 iii-i-C 'p ` S77 1 9820 I PROPERTY TAX#:
<br /> dVf'2.rr L"-'*.
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> :.... . . . . : is, :' CONTACT`INFORMAiT10R. ..
<br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): \LL l..LCr ,
<br /> OWNER MAILING ADDRESS: STREET 0 /140' ( l h� ✓�
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: A 'FLA)„i"[31,v(p LLC
<br /> CONTRACTOR`ADDRESS: STREET /2.6'2.7 D L./6,6,( c X
<br /> SA-Yo Too - i S H CITY STATE tit/+4• ZIP %'92 90
<br /> CONTRACTOR PHONE: ge,6 4 CQ•- 052-9 CONTRACTOR EMAIL: 75' vt.J- ('c ///NrS® X4/1D" f Com
<br /> CONTRACTOR LICENSE#(REQUIRED): "169o/PL 86>3N.1- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)1±9.M,
<br /> .
<br /> PRIMARY CONTACT: 0 OWNER 111 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: �,s GAB rdL CONTACT PHONE: 425- -Z I (D •- 720,
<br /> -_- _,„6,,,i....p.-620-61-i-er-e---y/ CONTACT EMAIL: Cie.bs?crr(i //r}/2earzm6L1s- 1v''b&V,CoM
<br /> ., :- BUILDING INFORMATIO r Ag, ,. , .. .
<br /> Existing Use of Building: Contract Price of Work:s /44 57), 49°
<br /> Proposed Use of Building: 64 /'G1 Heat Source: tErGas 0 Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: .Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ll Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use
<br /> DESCRIPTION OF WORK:
<br /> 'R-4-91/101 L-u L14 V 74V 4-Al /o./ et T/2/pvt (!)1--" 77tio /:-Zee),2 Si p,k•4 /
<br /> Two /71-a1,/b wya s-2 S'i f.r,e's' AN✓b l',0,-,ii--//e/ rcNc,w swk
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1.1010 o' 1 a vraiA Y--i Irl (4 1)
<br /> , .MECHANICAL PERMIT APPLICATION ,t ,... . ... PLUJIYMBING PERMIT APPI,LICATI�OhI: ,
<br /> Fixture Fixture 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 A Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher I Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain $. Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain I 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 1 Water Heater
<br /> SPrRINKXER I#00:01.00(04.00#710C '' '..•; 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.lam 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 y 10 65_ b\., o
<br /> ‘ .(- 1- --- 5- -/4— /5
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) 0
<br />
|