Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> 4,111/ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (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 /> uu <br /> PROJECT SITE ADDRESS: ( c3 3 2 �� O flG-`- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION a <br /> OWNER NAME: C.F Cc7Ee-f(Glc TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET /x`133 2 ev,e4cc. i,( ..)6---- ' <br /> CITY Cr✓�-� r STATE C. , ZIP <br /> OWNER PHONE: Z062_YZZ- 371/ OWNER EMAIL: 7C6 3 797'c4 ejteon .)c_Co,1 <br /> CONTRACTOR NAME: ,&/WO2 K'f rua2%-yqc-oc57 <br /> CONTRACTOR ADDRESS: STREET (Z.?(C7 7G S7 'U <br /> CITY Z.4 6-7aVCYU6- <br /> STATE L1.449— ZIP q62J <br /> CONTRACTOR PHONE: ZO& _ 7(ir-`i' / CONTRACTOR EMAIL: Soo„nec 4ra y2k.J/U€7.�f` 7 C00'-‘ <br /> CONTRACTOR LICENSE#REQUIRED 6 <br /> ( ) "��--�-1 /��GJN CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6�(2 1 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: zct, _7(�_ L(9a f <br /> c\ (<%�91 SOIL) CONTACT EMAIL: R ,ks/Z`t/1 s 7-c c <br /> BUILDING INFORMATION <br /> Existing Use of Building: RC)(OC-7'7rel C Contract Price of Work:$ /6 k <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USER ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition \\emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: (20-or--7 <br /> e,-, <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 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 Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) 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 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 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 cumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and l com with the State Contractors Law 18, "CW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 4N ^L zot? PE #ClO - 00( <br /> 'rOwner/Aut ri ed Agent Signature .1 Date (Revised 0/10/2018) <br />