Laserfiche WebLink
= PERMIT APPLICATIO. <br /> iz <br /> BUILDINiMECHANICAL/ 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 /> u /n r� C `�l a .� /� <br /> PROJECT SITE ADDRESS: \ l (Z\no 12 k p PROPERTY TAX#: d_�0 II /3O.DI 3 0/ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: „(, ,,, TENAN B SINESS NAM (Commercial): v d /' <br /> 1/ z <br /> OWNER MAILING ADDRESS: STREET / /!�'l�lr ` "I � e I <br /> / <br /> (//}} // <br /> f. <br /> CITY _,. STAT �/"V P' ZIP ( V <br /> OWNER PHONE: 41 . -5 3. .5 6. , , OWNER EMAIL: <br /> CONTRACTOR NAME: D,v, , il <br /> CONTRACTOR ADDRESS: STREET (/1, .5 . 4 i2 _ ll— , <br /> CITY /V[ / STATE 66,0, ZIP q 3' <br /> CONTRACTOR PHONE: 3 b D— �,, -1u T 5 CONTRACTOR EMAIL: ('j vl,f,- g ak5 57-zit/,0 J, ' <br /> O <br /> CITY OF EVERETT BUSINESS LICENSE# EQUIRED): <br /> CONTRACTOR LICENSE#(REQUIRED): !�/ <br /> PRIMARY CONTACT: ❑ OWNER O\CONTRACTOR <br /> 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: r55 n._- ri„. ,1)ti) )o FX, CONTACT EMAIL: i) l't 7/ vn5-1- itio r t_ -j, ( <br /> BUILDING INFORMATION <br /> Existing Use of Building: 4A, v Contract Price of Work:$ <br /> 6/IP tiV <br /> Proposed Use of Building: '-cuvlL Heat Source: ❑Gas )DQElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair gT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WQRK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): - 1 O c <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 /> 1 Exhaust Fans(Resident+el} 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 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 c.-•ly with the State Contractors 4aw 18.27 RCW and 296.200A WAC.�/� ,�/� /� /Ciityy of Everett Official <br /> ll-Use Only <br /> 1 ak, ) ^fir 1 \ g_ 1 'f/ , PERMIT2-00I - Oq �J <br /> Owner/Authorized Agent Slgnat re Date t/ V (Reviiseedl4/15/2019) f/ <br />