Laserfiche WebLink
• PERMIT APPLICATION • <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> /111P4*%4;---A CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (R U€O' 1$111e1c 011irPi as.) , PROJECT SITE;INFORMATION <br /> PROJECT SITE ADDRESS: 34-09 It oc3teku.0 4 ME PROPERTY TAX#: OO43818 000 5.00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT;INFORMATION <br /> OWNER NAME: 17o9 G.1.6 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET ill 9 rs. ST $E <br /> CITY V'E j&ETr STATE W A zip g 2.0 3 <br /> OWNER PHONE: LOfi /4'9 7055 OWNER EMAIL: put4CAN 44 O KE a `(a oto v.wM <br /> CONTRACTOR NAME: SrAMia k5 0, 14E(r;,, <br /> CONTRACTOR ADDRESS: STREET <br /> cr r STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR UCENSE#(REQUIRED): CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): <br /> PRIMARY CONTACT: 111 OWNER - ❑CONTRACTOR ❑OTHER(Please•Specify) <br /> CONTACT NAME: CONTACT PHONE: Z.O 4 10 5 c <br /> pt!/4 C&I1 (+O K. , CONTACT EMAIL: )Q,LA4 140 Kg C. Ot • ePM <br /> `BUILDING INFORMATION <br /> Existing Use of Building: + fP-0x Contract Price of Work:$ <br /> Proposed Use of Building /10 C- tin Heat Source: OGas tric •O <br /> BUILDING USE: F nhouse plex •� yl mercial Ucessory Structure <br /> Type of Project: ■ ■dition ■model 10 pair MI. �n ■rinkler rnolition ir <br /> ange of Use <br /> DESCRIPTION OF WORK: 5SvJER/4.1-0 wA-r K- VA- is 1J%I.tp2W D!3 Z 4t ! J.b Fs w' _u e.r 3 f'I' <br /> .4brC. ISJ W�- (0,4. 'DF`lw/4t�-. oe(;cF+k� t tceA4 f 06M1-1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Q��P R� c <br /> )J <br /> MECHANICAL PERMIT APPLICATION . . ..PLUMBINd.PERMIT APPLIC <br /> Fixture F;Mu e 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 Z Dishwasher 4 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain 2. Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor- r ase Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Intercep. -Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medi Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log -.•f Drains Water Heater <br /> ,,. .SPRIISIK Mitt SUPPRESSION:SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I 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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1 11 J 2 Zo PERpIIITj# ro <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br /> Vz- <br />