Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDI1. MECHANICAL / PLUMBING / SIGI*SPRINKLER/ DEMOLITION <br /> E V E R E T T CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WAS H I N GTO N (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 /> PROJECT SITE ADDRESS: 3,.7 2- , > PROPERTY TAX#: Q U`/ - f' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> TENANT BUSINESS NAME(Commercial): <br /> NAME: �";}1.� � r� �� , -�'�'��� � ( ): <br /> OWNER MAILING ADDRESS: STREET�‘�-ci j c).� :S)d <br /> l,_ / <br /> CITY V e. STATE l ZIP Cr J 2.CA; <br /> OWNER PHONE: :4--5 Z <br /> ��'" %/0(..1) <br /> OWNER EMAIL: �r�t. 5�,.��Ic,'S�•�(, f.4;,{t to-4-1 <br /> CONTRACTOR NAME: Wott t -Pt c , <br /> CONTRACTOR ADDRESS: STREET ( 7 zi 1. I, . 5l. 5- <br /> CITY /4U'.1 r >= STATE A ZIP q ? 7 <br /> CONTRACTOR PHONE: 3 to I "g6 J CONTRACTOR EMAIL: 5 4-���� i��^ . <br /> CONTRACTOR LICENSE#(REQUIRED): Vki 0 c.FEP I ti i 3 CI CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (j 3;k&`(0 <br /> PRIMARY CONTACT: El OWNER .ONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 }j.-5`I 'z r i '7 <br /> S 4-1,i LOi jt CONTACT EMAIL: `j.fi{ -'i-t) 7r 4 Cc <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work: $ (, s i U( L' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU 12/lulti-Family-#Units: 7 7 ❑Commercial ❑Accessory Structure <br /> Type of Projectew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: utout_s5.6 <br /> <" r <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 '-1 Backflow Preventer(Inside Bldg) ' 7 Shower,Tub,or Combo <br /> Boiler Gas Range 7'7 Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless 7 ' Dishwasher 16 7 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain I Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior 6 Floor Drain y3 Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) 5 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 ;,Z, 7) Roof Drains a Water Heater <br /> SPRINKLER/ SUPPRESSION SYSTEM q 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 /> <11"1.1 <br /> � PERMIT# <br /> Owner/Ruth ' Agent Signature Date (Revised 10/10/2018) <br />