Laserfiche WebLink
• PERMIT APPLICAT I <br /> BUILD I / MECHANICAL/ PLUMBING /SIG /SPRINKLER/ DEMOLITION <br /> EVERETT CITY 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 or Black Ink,aply•P ease] . , _..: ..PROD CT:SITE INFORM 1TION. . , .'.; _ ,.,, .. ...,, <br /> PROJECT SITE ADDRESS: 17 DLt 5,L&i v' q fl 2.12.3 PROPERTY TAX#: f S-4 911-L0O600/00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACTQINFORMATION. . <br /> OWNER NAME: `A11 l /4 'JV S EA, TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET /7 0 41,^ i Ay' y Jd�y <br /> CITY � {�i G STATE L��t ZIP 9 C <br /> OWNER PHONE: OWNER EMAIL: <br /> .f�t CONTRACTOR NAME: :-- <br /> ���t7� <br /> CONTRACTOR ADDRESS: STREET <br /> • <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: • <br /> CONTRACTOR LICENSE#(REQUIRED) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> x'ttn.gnntta't,Q�sw'rtbre,•�a..u�...v.:::iw.�Xw,�,4nae,N3 ! s9v'ro,:cvm..a •,xxa..Rt\,ntkt».::vmt::.. 'm;�.womYmx,. <br /> PRIMARY CONTACT: tR OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: G%Z '7?,17 -- <br /> CONTACT EMAIL: ' AJ ,4eitz(AD f J{L r <br /> Existing Use of Building: �f% Contract Price of Work:$ vim© ®� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE:filSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: Cl New DAddition El Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> WO o b �t G tJl C&� A <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECH IN��A4 PERMIT APPLICAT ON „„ N. .. ,.. PLUMBI.N ;.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 /> NC—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 /> SPR NKL R 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 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.l am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 7.0 <br /> Owner/Authorized gent Signature Dat (Revised 4/15/2019) 1/ <br /> Z <br />