Laserfiche WebLink
0 0 <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL I PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />EVERETT 32CITY OF EVERETT PERMIT SERVICES <br />00 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />Blue or Black Ink On Please PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: ^ :.% , ,3-3;5 <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />C NTACT INFORMATION <br />OWNER NAME: I"TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET % <br />CITY STATE LP ZO <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET r` <br />\\ <br />CITY �. �f 1 STATE I,—,) zip �J , <br />(J <br />CONTRACTOR PHONE: Z5 J g Z <br />EMAIL: <br />jCONTRACTOR <br />CONTRACTOR LICENSE #(REQUIRED) <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />(3 0, �) � r, ', -�' <br />CONTACT PHONE:��� <br />CONTACT EMAIL: Q <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: <br />Proposed Use of Build'K: <br />Heat Source: EIGas []Electric' ❑Other <br />BUILDING USE: FR ❑Townhouse ❑D lex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition emodel ❑Repair ❑T.I. ❑Sin ElS rinkler ❑Demolition ❑Chan a of Use <br />DESCRIPTION OF WORK: � r ��i "z�q <br />J, WPL0-:5 � L Gib '-� m CA-*i F,(Z) <br />f'um a oil <br />ASSOCI Btf1t IT # if applicable : tL <br />MECHANICAL PE IT APPLICATION <br />PLUMBING PER <br />IT APPLICATION <br />Fi <br />Count <br />res <br />Fixtvrs <br />count <br />List of Fiartur®s <br />Fixture <br />Count <br />, „, v ' <br />quit <br />Fixture <br />Count <br />List of Fixtures <br />A/C - Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat PumpBDuctless <br />Dishwasher <br />Sink -Residential (kitchen,bath,bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not HeaUAC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />Roof Drains <br />lWater Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other. <br />Water Suppression System <br />I <br />JNo. of Heads <br />Chemical Suppression System <br />I <br />lNo. 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 />own KAuthorize gna <br />ate <br />City of Everett Official Use Only <br />PER <br />(Revised 1011012018) <br />Y2,o,D'300* 00 <br />A.A/Z <br />