|
PERMIT APPLICATION
<br /> ILII
<br /> G::
<br /> BUILDINECHANICAL I PLUMBING(SIGN RINKLER I 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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> < PRO,IEC,�T.SIlE:INFORMAT c N S S M M
<br /> ��tue,nor 8�c ��T�Q�1�.P:le�se^IM. '�..��...,.. � ,.,y,.> ,.,, .`...., . . .. ....�.�yi _,. ..�,.. ,w.n...... . .,� ., _.,_NEMS1,.,. o.:8,'.�,,..
<br /> PROJECT SITE ADDRESS: /?/j/t(e'jtIrrt Et/aft-ft GvA 9�.2d, PROPERTY TAX#: 0OSgy74C/©a�OO
<br /> r ii
<br /> LEGAL for new construction: Short Plat/subdivisionjf A 64141-01- lath O1/P of No 2-Y v"(attach copy of long legal description)
<br /> .. .� .,,.�C R A. 1 , ..vF • , :. : i .x... g ._. ;,
<br /> OWNER NAME: oA 4- lex('(RAke_ (Ale-a v'f TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET J?/c (Me-I!CM Av.-- �7
<br /> CITY g Jerre STATE 614 ZIP /3'40/
<br /> OWNER PHONE: (-12-5- 513 $r67 02111NER EMAIL: t(°bE.rr �frf -212 I �i' Lt rt .Coe'E
<br /> CONTRACTOR NAME: Ail A-
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: A OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: q2_513-73- 867c / if2.3-Z 2-0- ?OH
<br /> (Are-444 — t/tk(t P CONTACT EMAIL: err?,0t/e fa't{ye et.j L,640.Ccs'
<br /> � GI�
<br /> .
<br /> Lit `1:�1 N;I=IR,RNIA'T
<br /> IDN
<br /> at M r z
<br /> Existing Use of Building: Contract Price of Work:$ 3 Oc,C,,"c'
<br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: XNew ❑Addition ❑Remodel CI Repair ❑T.I. ❑Sign CI Sprinkler ❑Demolition CI Change of Use
<br /> DESCRIPTION OF WORK: Q (j i 4 f , A„,„5.,_.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ... MECHANICAL PERM T APPLICATION :PLU1. BIN PERMIT/ 1'p,...C 10. ..
<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 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 /> AIR_toss Ko*FtWOMtititialttitlifriffaZ 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 lam 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 /> Ifit,1/ALL. (7 PERMIt 101, 65, fiV to\
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
<br />
|