Laserfiche WebLink
• PERMIT APPLICATION. <br /> 11121 <br /> BUILDING / MECHANICAL / PLUMBING /SIGN /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 Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 0 Etiatr l hAir (.J'i sikie 5015 PROPERTY TAX#: Z`'m 5/''003 p$ s-00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 1 CONTACTR INFORMATION ./ <br /> OWNER NAME:T-P) U .qe/- LVtorel-')Lo(dl,� 1—6 TENANT BUSINESS NAME(Commercial):.9/11ter ( mUv(Lkf lg(I,� <br /> OWNER MAILING ADDR SSS: STREET i 0I , t&n-0p C'� ;.53 00 I I/ <br /> CITY ieM / IG ✓ STATE 1 n/A ZIP '/ U M/ <br /> OWNER PHONE: 11 I� OWNER EMAIL: VVV'��� <br /> CONTRACTOR NAME:�QhG1) NeG t.t c\ .• <br /> CONTRACTOR ADDRESS: STREET ,0 I 7� /VW 7 f f1/, NE <br /> n7C/ <br /> CITY VO6tVI✓t lic, STATE t/1/A ZIP (�073 <br /> CONTRACTOR PHONE: YZs `41 gI 2 G 6 6 CONTRACTOR EMAIL: /U7�Q ()Ql 0011/ *Cil•COP) <br /> CONTRACTOR LICENSE#(REQUIRED): TO Q,v Z/>,3 pk CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 02 y27Uf <br /> PRIMARY CONTACT: 0 OWNER KI CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: pp CONTACT PHONE: (t/S—(Is/ - 'Z,Z‘6 <br /> �L^anSer, (�L6iccrt(`cat) :1—a)I, CONTACT EMAIL: ...Ltfy I e T '' o"iatrn.(oh <br /> BUILDING INFORMATION Existing Use of Building:' (eCOAVAUril-44l'#n-C Contract Price of Work:$ , /0/ s/p� <br /> v <br /> Proposed Use of Building:• te Corn Mutt Ai[o As/ Heat Source: ❑Gas Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial Accessory Structure <br /> Type of Project: New t4Addition <br /> / /❑lRemodel►,,,�❑��R[ep/air ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:1j- 7t /l WG// /"+r^'ii/e GA04, •CYLS647 and fe r 15 tl'e God [0o/ ifi c ,), <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 /> 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 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 /> ` )�( �y City of Everett Official Use Only <br /> �` //L U/dv ° PERM,Iz �00 —Ot 1 <br /> Owner/ uthorized Agent Signature Date (RevisedY1�0/`110/2018) <br /> `17 <br />