|
® • PERMIT APPLICATI•
<br /> LI
<br /> BUILDING / MECHANICAL/ PLUMBING /S GN SL_PRINKLER/ DEMOLITION
<br /> EVERETT CITY OF EVE MIT SERVICES
<br /> 3200 CEDA EET,EVERETT,WA 98201 \1
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-885 I(E)everetteps@everettwa.gov I wwyverettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SI NFORMATION ,--7
<br /> PROJECT SITE ADDRESS: 15-01 6,14�44A'L2r- (,,l)A-1I PROPERTY TAX#: 90 Sr-O'D010D9 DO
<br /> I
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. 1 (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: T to Osor - LA i r—a TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 1 �� 1r1 4-lr,,e r— t (3e) /t
<br /> CITY `E.Nsg„re. STATE U.i A+ ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: 2,,- , + , .> _ =',i
<br /> CONTRACTOR ADDRESS: STREET i t:`i 1 , ,- ,t.,a k, L,--::,i .L.,,4, 14 ',I . tf.;
<br /> CITY -i .3-c,,-tk STATE L,, vl ZIP i;I}('/
<br /> CONTRACTOR PHONE: _.: CONTRACTOR EMAIL: C(. )il.:-Li. < z : -
<br /> t 1
<br /> CONTRACTOR LICENSE#(REQUIRED): a 0 STO b ry B J (5O6 CITY OF EVERETT BUSINESS LICENSE#(REQU ED): jlle
<br /> 1
<br /> PRIMARY CONTACT: ❑OWNER .CONTRACTOR OTHER(Please Specify) ' �,�J� U30' yJ r
<br /> El4
<br /> 1 1„,
<br /> CONTACT NAME:: CONTACT PHONE: 1 , /, �( ,v4,Fj 2
<br /> ?, ; , �'►i,i r1A- CONTACT EMAIL: i'1 ( c'�'-:, c.`
<br /> 't I
<br /> BUILDING INFORMATION 9P _
<br /> Existing Use of Building: :'`l Contract Price of Work: $ rF' 4i' t33�U'
<br /> Proposed Use of Building: ') ii Heat Source: OGas DElectric ❑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: ), ,. i=--- - 33
<br /> l i
<br /> is ni �� 1 ,r>9 c — if c/pliol c s (6-y6 i '67 Lit y :t) ac.0
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): L(fee •�`� I I
<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 /> NC—Air Handling Units y 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 Ventilatior Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) I 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 I Other: ri i5&/ Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> SPRINKLER I 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 /> PERMIT /� L �6,D
<br /> . . rt v�
<br /> Owner/Authorized Agent Signature Date (Revised 10/1 20 8)
<br />
|