Laserfiche WebLink
PERMIT APPLICATION <br /> ,IPP BUILDING MECHANICAL I PLUMBING I SIGN I SPRINKLER!DEMOLITION <br /> ./*4/4.41:1 /-4411144. CITY OF EVERETT PERMIT SERVICES; <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps{n evveiettwa.gav( www:evefeftwa.govfpermits <br /> tittueor Black Ink only,Ptt e) Rc4;1) 6 `. ' i 1FORMATION; <br /> PROJECT SITE ADDRESS: , 2. t: J PROPERTY TAX#: <br /> LEGALfornew construction: Short PIatisubdivision Lot No. (attach copy of Iong legal description) <br /> OTllT"INFORMATION <br /> OWNER NAME: "" 1"""'4 S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS.. STREET )2 'tA Ave, <br /> C" STATE \ ZIP c) <br /> OWNER PHONE: 4-2,5 „2 6 10 OWNER EMAIL: ‘ h 00 COrvl <br /> - <br /> CONTRACTOR NAME: - )P2„.00'r` ( - 1 ,,,„. (... . <br /> CONTRACTOR ADDRESS: siREET,zoci-2)2 , 'V\ <br /> crrY t e.. STATE ,..1:41-- z1Pd).22` <br /> CONTRACTOR PHONE: ~` , `" CONTRACTOR EMAIL: 4 d a ,i at:, y i Of *. <br /> CONTRACTOR LICENSE (REt t€itREo): <br /> CITY OFEVERETT BUSINESS LICENSE#(REQUIRED)M5 41 > <br /> PRIMARY CONTACT: D OMER CONTRACTOR 0 OTHER(Please Specify)' <br /> CONTACT NAME: CONTACT PHONE: ` <br /> CONTACT EMAIL: a illCAI 0 j .it, g F .lb <br /> „'SUILDING`PERMIT A$UCATIONI <br /> Existin Use of Building: Contract Price of Work:$ e ' 0 _,._ <br /> Proposed Use of Building: Heat Source: ®Gas ©Electric IOther <br /> Building Type: I SFR-Detached 16FR-Attached; ODu lex QMutti-Fatuity €of Units: C3Commerctal °Industrial <br /> Type of Project (New ©Addition URemodel °Repair UT,I. °Sign °Sprinkler Ofemolition 0Change of Use <br /> DESCRIPTION OF WORK:' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT A Pk i TIOlN, ^`' PLUMBING PERMIT APPLICATIOPV . <br /> Type of Project:;. New Addn Alteration __ ,Repair Type of Project: New _Addn Alteration; ,,,„,,,,,Repair <br /> #of #of #of #of <br /> I <br /> List of Fixtures List of Fixtures List of Fixtures List of FixturesFixtures Fr`xtur Fixtures Fixtures <br /> AVC—Air Handling Units Heat Pump: Toilet Backflow Preventerr(Inside Bldg) <br /> Forced Air Systems ti UnitHeater ' <br /> BathtubUrinal. <br /> Gas Piping Boiler Lavatory(Wash';Basin)- Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Eink,S Disposal .,,,,,,Grease Trap <br /> Gas Range Ducting', Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan, Sink(Service/Bar/Mop/etc) Other: l <br /> SARI [IDLER 7=SUPPRESSION SYSTEM .' <br /> Chemical or Water ' _INo.of Heads <br /> ACKNOWLEDGEMENT:t 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 ors permit only authorizes approved work end no deviations therefrom..Deviations must first be authorized In writing from the <br /> 8w/ding Official before being authorized under any circumstance.I am the owner,or t am authorized>bythe owner of this property to perform the work for which applicalIonn is made, <br /> and I comply with the State Contractors•Law 1527 RCW end 296,200A WAC. <br /> City of Everett Official Use Only <br /> a <br /> � <br /> PER <br /> ttiAITAli <br /> 41/IJ <br /> *ill/ e-/-/ --7- <br /> bnit- orD4 <br /> eriAuthorized,Agan;Signata a Date (Revised 9123/2016) <br />