|
PERMIT APPLICATION■
<br /> tliP/111°:-. —A BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue or Bl11:4it1.1IC tOnly.Pleas®j; , PROJECT SITE tFONMATION ,
<br /> PROJECT SITE ADDRESS: i bl'?:1 Jerc,,,,44„ (,0t,,/ I 0 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision C' Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: Vac, Ply ,4s5elCA 0i SOr c TENANT NAME(If Commercial): ‘--yr-C), 1/10C4,
<br /> OWNER MAILING ADDRESS: STREET (D( C S C3t,' Si. ) S(A;k �/,I c
<br /> cry I Ie�tLL STATE CA.-)0- ZIP C.3 00()
<br /> OWNER PHONE:`1 . - 9 90 (9)CO OWNER EMAIL: 5-1-
<br /> V191/Ia v1Ike (J 1)Ok-fid U 1 SC 5,c ov,
<br /> 9
<br /> CONTRACTOR NAME: e,e:::,* v Sl robe-e
<br /> CONTRACTOR ADDRESS: STREET I�), 'D 604411 50-el p/ fi{/.y j�
<br /> CC„ � ,pT`\ Cv *— STATE( )/ ZIP t G loia
<br /> CONTRACTOR PHONE:ya'c -330 $I(06 CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): u.TSJS 6. pa CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):c..-S/04
<br /> ,. ,. .._v..., ,....._, ... .,... .. _y.. _ .. ..,. , . , . �,._4_� .0
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) 5k,V O 1-..C{
<br /> CONTACT NfflAE: CONTACT PHONE: 4.-1 ?C 3._ 417
<br /> 1 LeiViikl .. Qrt- CONTACT EMAIL: € 803J112A),.,/ , n C_a�
<br /> .. , , BUILDING PERMIT A'PPUCATI N. ,
<br /> Existing Use of Building: Contract Price of Work:$ 2c O'
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.!. FiSign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: I f neA4 G r L 0 C\Ac J I
<br /> Ji „ ,F, (,
<br /> a Lo 70 gc><-6
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICALPERtM,IT APPLUCATION,r ,. , ` PLUMBINta ,P IT APPLICATION ` ., .
<br /> Type of Project: New _ Addn Alteration _Repair Type of Project: _New Addn _Alteration _Repair
<br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&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:
<br /> SPRINKLER F-SUPPRESSION.SYSIfEM
<br /> !Chemical or Water I INo.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 onty 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.lam 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 aw 18.27 RCW and 298.200A WAC.
<br /> City of Everett Official Us[(h _ oe Only
<br /> �"" ) K.
<br /> PERMIT#8 !1f)„,...
<br /> Owner/Aut d Agent nature Date (Revised 9/23/2018)
<br />
|