|
PERMIT APPLICATION
<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.govI www.everettwa.gov/permits
<br /> {Blue*BW4Vtfik n1yJ'lease/' ' , e` 'RO,JECT 1TE,'IN :O,OATI:it*:t ,, '§rit a ,`.... , * NSA I '
<br /> PROJECT SITE ADDRESS:Ioo I 511°K5h4 WAY EVERE-r7 w q 95241 PROPERTY TAX#: 2 809 v 1 003 00 2 ob
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ��" C. M M F ONT CT INFORMA '10N.F���''�III,, " ,,.��
<br /> .�.. _ .go- ,,,�,r.., i„�7- �> ..u„a; .?..�.,, ,.w....... f �,. �. .r-...� - ,- _-... xc.�.%..,r.
<br /> OWNER NAME: FOOD S6R VIC ES O F APiE1e,tc_A TENANT BUSINESS NAME(Commercial): U S FDOlJ S
<br /> OWNER MAILING ADDRESS: STREET /9y30 C ALL T wY
<br /> rs� cm, 1C.EN7 STATE vt,/A ZIP 9003 2
<br /> OWNER PHONE: 1Tr 7 63/ 32-16 OWNER EMAIL: J D(JRA/J /rr O,V t 0 . GG
<br /> CONTRACTOR NAME: PLUM8 61GNS
<br /> CONTRACTOR ADDRESS: STREET 909 5 S. 2(7/4 57.
<br /> CITY TAGOM A STATE W A ZIP /8 %,9
<br /> CONTRACTOR PHONE: 253 973 332-3 CONTRACTOR EMAIL: 6,i 44 r /v.r+bSi S4 S • C 0
<br /> CONTRACTOR LICENSE#(REQUIRED): PLu^'1 as, o 7-) 4'S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Vt Z 8'S
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: BR I A>u S R OS Nam CONTACT PHONE: 2 53 '-j-J� 33 Z3 k7 tE
<br /> CONTACT EMAIL: br;wvie ��v,pbS;gnS-GUn
<br /> M10400. ,'I ,. r1.0AM f .>BU11=`DINONFORMATION'4 MNAINN,SMSSA_ . . SA,. uE SIMIS
<br /> Existing Use of Building: Fn°O SERvi C(S Contract Price of Work:$ "6/OW• 0.4
<br /> Proposed Use of Building: F000 SE-Q .i ice& Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. KSign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: INSTAt.L(j) B/F lLLUMINA9F0 Maluwelt•.r1 Sib,v j (1, SF7 Or evv,t-760
<br /> D(f1e',stonal LE77E4.5 Rct.o,1v1. vs FaoOS", (L) DI12EG7faar+3 04( 4 ovIGE / a,uC stv�c,E
<br /> FACED) (,Q FL-A7 ,c.u7Ni,vvm St(0) av't0,4,1- " 2.(CEtvtnll, oFFtGE
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> iilig: ;MECHANICAL IERMITTAl:.*LIGATION .r, &PLU,MBING,PERMIT AP,P,L:tCAT10N1:a ,r,, , ,, ;
<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 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett OfficialOfficial Use Only
<br /> .3. / l PERMIT-#,., q jlllG-002
<br /> tzed Date (Revised 10/10/2018) (f
<br />
|