Laserfiche WebLink
® • PERMIT APPLICATION• <br /> BUILDING / MECHANICAL I 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.gov I www.everettwa.gov/permits <br /> -(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: . :( LUJ-124V - 6V8,1?-:a 0/ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _ CONTACT INFORMATION <br /> OWNER NAME: Z k i X I Q 06, L ( (j( / apt TENANT BUSINESS NAME(Commercial): FvygAt ,_ , ij D n =Ric <br /> OWNER MAILING ADDRESS: STREET f e+ Bq/ G-- g Fid Q/� / m �°� <br /> CITY STATE ZIP q k✓J2 <br /> OWNER PHONE: V2 5 _ 6t T 5 66 1 8 OWNER EMAIL: Xi D` /�V fJ,'6066 <br /> ey,thop . C <br /> AS �CONTRACTOR NAME: /Vd P`g Cff A/ We ( !/� y e C?�� <br /> CONTRACTOR ADDRESS: STREET i <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: — 9 �y b CONTRACTOR EMAIL: //V67 eaNy/7,-(* qj v/W r <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQ IRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ��OTHER(Please Specify) r s 1 4✓v�`r 24-C <br /> CONTACT NAME: CONTACT PHONE: 20& - 3- 32„3 <br /> N O S Wow(rya �Gd FGk.021eS 1(1dtS l J o) CONTACT EMAIL: /10S c cih,c#-J e6. 6 t <br /> ,^ BUILDING INFORMATION <br /> Existing Use of Building: B - IIl/vliti (UeSs Contract Price of Work: $ 3 (7 ( <br /> Proposed Use of Building: A 2.,°' -fk f-tkilt- Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ,'ommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair XT.I. ESign ❑Sprinkler ❑Demolition ❑Change of Use '"DESCRIPTION OF WORK: rn6.�,Qe ( res-L 4 1�4 GI y6 s ' UacVS <br /> / <br /> ASSOCIATED BUILDING PERMIT#(if applica <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count Li f Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units as Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> oiler Gas Range Clothes Washer 5 Sink-Commercial(3-comp,prep,floor) <br /> Clo s Dryer Heat Pump&Ductless Dishwasher 2., Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remofidef)' Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans•(I idential) Commercial Ventilatior 2„, Floor Drain T., Toilet <br /> )e2,Exhaust Ho (Type_I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaus 'ood(Type IT-, Water Heater / Interceptor-Grease 1 Waste/Water Piping Repair <br /> Ex st Hood(Residential) _ Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> rced 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 I 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 1 comply with the State Contractors L 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> r# <br /> 2---/ /2--.C.,--e_e=3 ,V- 2p02 , On <br /> Ow r/Autho • g nt Signature Date (fievi •d 10/10/2018) <br /> /7- <br />