Laserfiche WebLink
NMI • PERMIT APPLICATION• <br /> ni <br /> BUILDING/ MECHANICAL/ PLUMBING I 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: /)6. Ca 1.4e A-vvi'we., PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> /� CONTACT/ INFORMATION <br /> OWNER NAME: I&rt� "7/:/4et I /✓/3Tr!a -/ TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 3/00 roadpu ay 4w_, <br /> CITY L Ye.4 STATE ZIP lt/zo/q <br /> OWNER PHONE: ''.,;/r 12 j -3e5--100 OWNER EMAIL: D IA)a I t/&ev'C'2 I5d a (Jv j <br /> CONTRACTOR NAME: t BC (1,ol/15 trL'�'r0 tJ <br /> CONTRACTOR ADDRESS: STREET Co 2.4 /70-71-1" 17(.... N, <br /> CITY %F L E V'U STATE ZIP leach <br /> CONTRACTOR PHONE: `.X - 7-4'2--'7-7-40 CONTRACTOR EMAIL: nal/hart (2jGr4O, /!r0e-1cc , €011i <br /> CONTRACTOR LICENSE#(REQUIRED): 1..6 C cc, g?j) Iki CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): G 011 (, <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 'OTHER(Please Specify) A-vcl'i, fral- <br /> CONTACT NAME: ,'le5 vie4 3f CONTACT PHONE: 1ZS — ZS1 8 <br /> N ��(( L <br /> �� /�rC� 1 t e c CONTACT EMAIL: yyi/105 byl Li arch, &Nil <br /> BUILDING INFORMATION <br /> Existing Use of Building: 5C l 4CCi/ Contract Price of Work:$ 9 g j Zso <br /> Proposed Use of Building: 5,11 cc,/ Heat Source: Eiltas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU DMulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition Memodel Repair ❑T.I. ❑Sign -t❑Sprinkler ❑De�pmolition DChange of Use <br /> DESCRIPTION OF WORK: ��} ��B CJ Y1Ca-) (JtOGY> OtV.EJI ov �I�T i01�1 WC1 lS <br /> t v\- 6IA-Vra►nCc Ub19 Leer 1 j�crec`�e.4 SeCurt 4- r <br /> / y <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 Ventilatior 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 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.I am the owner,or I am authorized by the owner of this property to pe,fomi the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> GG i ,� City of EverQet�t OfficialJ�Use Only <br /> Ofj <br /> /�"w / ?°/ <br /> lJjPERMIT# i�j}O .., Vo�ner/Authorized A ent Si nature (/ Dat [ (Revised /1 / <br /> g g ( e sed 10 0 2018) <br />