|
NNE PERMIT APPLICATIO•I,
<br /> BUILDIN( IECHANICAL/ PLUMBING /SIGN IRINKLER/ 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 1 www.everettwa.gov/permits
<br /> (Blue,or Black Ink OnlyPleasej„.... . .,,. `ROJECT SITE(INFORMATION .. ,
<br /> PROJECT SITE ADDRESS: 3 gag", //i /1 PROPERTY TAX#:04•4c,/39eac/o //d0
<br /> LEGAL for new construction: Short Plat/subdivisionty Z•'».deo s / i' Lot1Slo/4/Z (attach copy of long legal description) a/4 ./
<br /> , .NFORMATIi l ... . .
<br /> Irt�NT d I
<br /> OWNER NAME: 33007 ,'74 // GGG ,TEENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET Z 9//7Z, Al 4.w/7 /�v*. 5'r . lt dz"Z
<br /> CITY c��.G..e !T STATE L,,..,f AZ ZIP '':?6 ,. .".1OWNER PHONE: 4/25'.—0/Lf -7 e 0, OWNER EMAIL: /G� 4 .t
<br /> E .1 4..c,,t-&re oci s 4i em/Au.C ,M...
<br /> CONTRACTOR NAME: Qwn/ .,,L,,,
<br /> CONTRACTOR ADDRESS: STREET .5;4:::'m�
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: S`.090-1-7 . CONTRACTOR EMAIL: S ,.o,.v/e
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 6WNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> CONTACT PHONE: G)/ —Z, /G ---1Z5--
<br /> Z N./ .0 E.-.t-"74 CONTACT EMAIL:
<br /> BUItliki4 G INFQRMATIOT
<br /> Existing Use of Building: /,04'trc Xc.,,,,-,.. Contract Price of ork:$ ikke)
<br /> Proposed Use of Building: aa ih.Et Heat Source: •-as ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: - - - ■Accessory Structure
<br /> Type of Project: ❑New ❑Addition • emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use
<br /> DESCRIPTION OF WORK:
<br /> 14WI c5-10//...3
<br /> - -- - - c.2-re/ o- ,DhD c4 n6z USS' -
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): la , Rd�1�.��`/
<br /> MECHANICAL PERMIT APPLICATION .:` ,. , PLUMBING PERM41IT APPLICATION.;. �
<br /> Fixture Fixture 5
<br /> Fixture List of Fixtures Fixture List of Fixtures List of Fixtures List of Fixtures
<br /> Count Count Count Count
<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) 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•ranting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building Official before b-'n. . •nzed under any ' ms-•: . .m the owner,or lam authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with t de ate�y + •rs La 'and 296.200A WAC.
<br /> .I City of Everett Official Use Only
<br /> PE I
<br /> i,4
<br /> IY_Aos _ ou ,
<br /> "..
<br /> / Date (Revised 4/15/2019)
<br /> (YZ-_-)
<br /> Owner/� •• Agen •nature
<br />
|