Laserfiche WebLink
PERMIT APPLICATIO ' <br />BUILDIN�MECHANICAL / PLUMBING / SIG*PRINKLER / DEMOLITION <br />EVERETT 32CITY OF EVERETT PERMIT SERVICES <br />00 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION . <br />PROJECT SITE ADDRESS: o(� l� C �,'(�5-c (} <br />PROPERTY TAX #: G?L� L �L-I 56) L <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: p TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET a G� <br />CITY �l l Ik STATE ZIP <br />OWNER PHONE: <br />OWNER EMAIL t p{ . <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET j (w <br />CITY ,ye, STATE w ` ZIP <br />CONTRACTOR PHONE: �D(� ,C.1 1j Gig <br />CONTRACTOR EMAIL: <br />L C l h <br />CONTRACTOR LICENSE #(REQUIRED): 10(• <br />(�L LL C 5 <br />CITY OF EVERETT BUSINESS LICEN E #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />` (lW 1 <br />CONTACT PHONE: V <br />CONTACT EMAIL: 61, 11 O 1� 1-d l <C <% t <br />BUILDING INFORMATION - <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: t <br />Heat Source: []Gas Electric ❑Other <br />BUILDING USE: PSFR ❑Townhouse ❑Duplex ❑ADU []Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Projec . ❑New ddition ❑Remodel []Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: � da e-( C( <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />f <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C —Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />I <br />Gas -Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />A <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />1 <br />Sink -Utility, laundry, mop <br />Exhaust Fans ( eside t I), <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood ( <br />Hose Bibb <br />Urinal <br />Exhorr'st Ho pE II) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust od,(Residential) <br />Wood Stove <br />Interceptor-Sand/Oil V Z, <br />lWater Service (behind meter) <br />Forced Aif Systems <br />Other: <br />Medical Gas <br />lWater Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejeefor or Sump Pump <br />Other: <br />Water -Suppression System <br />No. of Heads <br />Chemical Suppression System <br />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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />'L S Dl 210t�1 <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT #-�iq <br />(Revised 411512019) / <br />I <br />v <br />