Laserfiche WebLink
471ETT PERMIT APPLICATION <br /> BUILDING•ECHANICAL / PLUMBING / SIGN RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICE <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 01 elVirCiiCie. 12CA Ci I k' I5(7 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ?ci nQ iton fj 0-6,(6Iop netiv-t-- TENANT BUSINESS NAME(Commercia : 7 OWNER MAILING ADDRESS: STREET 61 C 0 f C L: I i(ii- St 1 61)1k. 29j6 <br /> CITY R i-Dn STATE 1/0 f ZIP i e Si <br /> OWNER PHONE: Z(A O` `'� r' ' 54(c OWNER EMAIL: v ✓ <br /> CONTRACTOR NAME: J terra (01,-,L orii-i Co t 2fl'1p(A,a / I vlt <br /> CONTRACTOR ADDRESS: STREET 1 elquo I4-1 AvL, _ jE <br /> CITY k)0 O I 0 t 1 ( 6 STATE ' ZIP `I 72 <br /> Fj--CONTRACTOR PHONE: 4 z, .19)-7--52c�0 ' ,r CONTRACTOR EMAIL: E r U 1 e 5 i e,rrt�rd z 6op14 <br /> CONTRACTOR LICENSE#(REQUIRED): G)I L RGC A 6 HS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 1.iL7j'3(7(5' <br /> PRIMARY CONTACT: El OWNER ' CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: n CONTACT PHONE: Ai Z5— A _ 200 <br /> r)11(AA P\LIB <br /> CONTACT EMAIL: 14S <br /> " (1n f @ (;IC.fl' C& I VC ' GOw'I <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work $ 4 i q OO Ott <br /> Proposed Use of Building: l;Lt4 4 e,4)01f =- /')-17j rage-. Heat Source: ❑Gas ❑Electric Dot r <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ET.]. ❑Sign Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OFWORK: <br /> x1A,K 4 i{- 00 f /GOV4 wIGv'L( ci. - — W GWG tiov-ac / 412v-ct.$2 . <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 /> 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 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 /> l <br /> Ow er/ thorized Agent Signature Date (Revised 10/10/2018) <br /> cal <br />