Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7/7 /a rAS f 4 E VCNGf GliGt PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision _ __Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 54t r301.,\A TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: /406../7-1 i c A ,4 t/-S //1 c_ <br /> CONTRACTOR ADDRESS: STREET p0 .) jY IC' 7 2 / Q <br /> CITY 1)26t(7S �� e STATE (j(/Q / / ZIP F[:) 2 <br /> CONTRACTOR PHONE: Ci $=_�y3 --ScA C �jCONTRACTOR EMAIL: c��m 6 aZIMS. mh �zj' (� c. C-(J� <br /> CONTRACTOR LICENSE#(REQUIRED):NA/415 PFF,5— <br /> O 3 // CITY OF EVERETT BUSINESS LICENSE#(REQUIRIED):at—C3-9 <br /> PRIMARY CONTACT: 0 OWNER A CONTRACTOR 0 OTHER(Please Specify) <br /> CONT•CT NAME: CONTACT PHONE: "Ii„?,_\^392_Yak <br /> /4// CONTACT EMAIL: cAh; ,.,6, GL!/4:5p/U/),4finci <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 3.5 00 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: I21Commercial ❑Accessory Structure <br /> Type of Project: SJNew DAddition DRemodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ins f4( it /'r�u Lc 5eyu Fiorn me r <br /> fh RO <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 /> A/C—Air Handling Units Gas Piping X 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 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 /> 71963- ( <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />