Laserfiche WebLink
EVERETT <br />WASHINGTON <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL I PLUMBING I SIGN I SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1(El everettens0everettw2.nnv I vAvw pvprpHwa nnvrnpr it* <br />(Blue or Black ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: . 3 I r>1 OS J. M A D-) S O O C <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: E�VL_tLl (JS j )` e, j_NANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 1 () L' } b ( <br />�—{ � /1 <br />CITY v �-- STATE V / % ZIP 2 43 <br />OWNER PHONE: OWNER EMAIL: t"a IwC�t? \,f V\f}. , d f` <br />CONTRACTOR NAME: S_rft_(z 200 F) " <br />CONTRACTOR ADDRESS: STREET &c01 I Z L(' 'rti' E <br />-7 <br />CITY YA ti I C I2-C:Z3 K— STATE L,-J (y A zip O4t L <br />CONTRACTOR PHONE -(ZS- Z 0 - 7 g'j Z <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): 57TA44 (., / S 1-j r, H JCITY <br />OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: WOWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: t"ri t.., e.cb -n <br />BUILDING INFORMATION <br />Existing Use of Building: <br />:ontract Price of Work. $ L- UO <br />Proposed Use of Building: `j 193"M CC <br />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. ❑Sign -[]Sprinkler [Demolition ❑Change of Use <br />DESCRIPTION OF WORK: n n ( (� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />c <br />List of Fixtures <br />Fixture <br />List of Fixtures <br />Fixture <br />Count <br />Lfst of Fixtures <br />AIC -Air Handling Units <br />Gas Piping <br />Backflow Preventer (inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Clothes Dryer <br />Duct System (Remodel) <br />Gas Range <br />Heat Pump&Ductless <br />Refrigeration <br />Clothes Washer <br />Dishwasher <br />Drinking Fountain <br />Sink -Commercial (3-comp,prep,floor) <br />Sink -Residential (kitchen,bath,bar) <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not HeaVAC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <br />Water Heater <br />Interceptor -Grease <br />WasteANater Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />10ther <br />Medical Gas <br />Water Valves or Fixtures <br />Gas FireplacelinserVLog <br />I <br />lRoof Drains <br />Water Heater <br />SPRINKLER I SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other. <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />No. of Heads <br />A&,rvvvwLruutmrtnr i s i nave 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 />PER <br />City of Everett Official Use Only <br />'--- <br />10 q - 2-1 D -02 <br />Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />