|
® 0 PERMIT APPLICATION
<br /> 11.11111
<br /> • BUILDING-1 MECHANICAL/ PLUMBING /SIGN / SPRINKLER / DEMOLITION
<br /> EVERETT f 32 CITY OF EVERETT PERMIT SERVICES
<br /> 00 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)
<br /> N)PROJECT SITE INFORMATION
<br /> ZC I/�
<br /> PROJECT SITE ADDRESS: ` 3Z (6Or� �'1- 5 EJZfe ft (,J4- �(("A4PROPERTY TAX#: 110 0�©S' �
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ( yyr 1��;1 s TENANT BUSINESS NAME(Commercial): (, 0if`,,_ j to„,„b.sn
<br /> t ;
<br /> OWNER MAILING ADDRESS: STREET "10-sLk OE I T3 i°, _ y
<br /> CITY Kt,",VAti J-e_ STATE w R ZIP 41 t�C,av
<br /> OWNER PHONE: 4 vv -JI`0 •- - S`'1 l OWNER EMAIL: i7`v iv
<br /> CONTRACTOR NAME: E.)13 7nGe -c cX Pec,ch0cA-S
<br /> CONTRACTOR ADDRESS: STREET .g00 (13fh A) - S.
<br /> CITY SGw#t 1 e. STATE G1 A ZIP q gl le
<br /> CONTRACTOR PHONE: -ZO t, 3 1/( — 33 v a CONTRACTOR EMAIL: ne....e,e,vt-kt+(}rj etc,fie, _ (..Cyr\ 19..LE
<br /> CONTRACTOR LICENSE#(REQUIRED):E. C1 .No.,131 C 0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):y- �—
<br /> PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ®-OTHER(Please Specify)
<br /> CONTACT NAME: 0 CONTACT PHONE: Li Z S'-- 2 L 1 - 0 76 (
<br /> !
<br /> �h'K' S-61 CONTACT EMAIL: )^Kn.1iA, 5 6) tnj C 1 G P• LO rvk
<br /> BUILDING INFORMATION
<br /> Existing Use of Building:UTT;ce, 1i,.)4rL11„,; c $t,:r',:,L'_ Contract Price of Work:$ i'i%;` 14 i°,1'‘ 2. e 6.0
<br /> Proposed Use of Building: OPT;w/.tom„✓•c 1,„,;50 - s f.,ct,f C, Heat Source: ❑Gas DElectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: QCommercial ❑Accessory Structure
<br /> Type of Project: LiNew `❑Addition ❑Remodel ERepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: (Ail./ W oul k ri` 1 ', (-o i..tllok A. .. L W1LZ"z•N+n-.KG.. /- L„ i',
<br /> (�G J�c� a5 Slttl�;w tJ 5tv,6 041rS'� GV. tU�'�, 1ti U
<br /> 3 P b 3 �,tF;n�s
<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 /> City of Everett Official Use Only
<br /> / PERMI
<br /> Nt05.......6,......7
<br /> Owner/A rized Agent Ignature /DaV (Revised 10/10/2018)
<br /> ` Z--
<br />
|