|
• PERIIIIII APPLICATIO
<br /> / r BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ (i-�EMOUil)OH
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> -"
<br /> ti�r_ dl/r� 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov everettwa.gov I www.everettwa.gov/permits
<br /> IQIIt© ©P l iiscch Tali OItj h y Pase) ��?_ , Pr. SITE MATRON _ ---
<br /> f J
<br /> PROJECT SITE ADDRESS: ' j Lb )a-V-e_ i,,J-tut b- o \ ' -� 1PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: !`Cl i_s 't/VJ r1 TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: sTREET
<br /> CITYSTATE ZIP
<br /> OWNER PHONE: d.06 —500 — Of 2--(, OWNER EMAIL:
<br /> CONTRACTOR NAME: A .,Row FL 'P te vi--)' ^'t'
<br /> ;CONTRACTOR ADDRESS: STREET``/09 a WO',
<br /> 'q riv, j170,1,11 e',- b•t,tic_ a
<br /> ' Cf !'.;.Y J/ rj,5 t STATE O', ZIP C JCL 7- s
<br /> CONTRACTOR PHONE: 4/2$- 30/ qiol CONTRACTOR EMAIL: tkr re Lam° t/6, cii-g is,-,4; i s C:'h,,
<br /> ,CONTRACTOR LICENSE#(REQUIRED): W J(ZOt i rp,g y7 plc CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): A 2 "-4.'
<br /> PRIMARY CONTACT: 'VI:OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: (-05-- 3 D/ - '1 O 1
<br /> E1 tA:S0A) 6)J10j') CONTACT EMAIL: cat('CD,.,,Jd (1, BL'j.0.14:I, ( C"
<br /> BUILDING INFORMATION
<br /> Existing Use of Building: Contract Price of Work:$ :_r 3 "I LJUU.
<br /> Proposed Use of Building: 7;w.I,c,:,PS Heat Source: ❑Gas ,E1Electric ['Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ['Duplex DADU ❑Multi-Family-#Units: ❑Commercial ['Accessory Structure
<br /> Type of Project: ,$New ['Addition ❑Remodel ['Repair EIT.I. ❑Sign ['Sprinkler ['Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: xh5107 r. 5-J fire_cf 47, 'iv,. �z5„ euiee-
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): _ !
<br /> MECH1AI'<IICAL PERMIT APPLICATION T 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 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 Ventilatio 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 I Water Heater
<br /> SPRINKLER/SUPPRESSION SYSTEM _Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System t � No.of Heads I 'JI
<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 /> PERMIT#
<br /> r lot b -- DOS
<br /> Owner/Authorizeden(Signature Date (Revised 10/10/2018)
<br /> , . v
<br /> :
<br />
|