|
PERMIT APPLICATIO"111.1*OiliN
<br /> BUILDING/MECHANICAL/PLUMBING I SIGN/SPRINKLER/ DEMOLITION
<br /> - CITY OF EVERETT PERMIT SERVICES
<br /> 441w3200 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 /> PROJECT SITE ADDRESS: /c-R ! 3 1-e- 01 tr ((/ PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: te-f- - TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET /Lf kr-- bi y
<br /> CITY �ve,r STATE(1/f�f ZIP 9E. a 03
<br /> OWNER PHONE: ,G Q 9 a'[s--66((�a ,o,� OWNER EMAIL: pf�r, S[2r//11X5 A S l rkf-D,S �;
<br /> CONTRACTOR NAME: Pistl 5b c,/1dt (r G_ s wez, inK
<br /> CONTRACTOR ADDRESS: STREET p�311 ll./ ,.n P' \
<br /> CITY 4,,,i 40,,,--1-t-_,. STATE ZdeG/t ZIP / ' Z r
<br /> CONTRACTOR PHONE: 7 3�-�t`j 5T 6 , CONTRACTOR EMAIL: A y',.ec j j av,xe,k,gay(,,,z,,,,A S 9 & ss1 �
<br /> �..e-;-s�g c I It `� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t;5- 1 CONTRACTOR LICENSE#(REQUIRED): ,,,,// I /
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) /veet/ a C—c�ti/ to — ff) L(t)`�
<br /> CONTACT NAME: CONTACT PHONE: 1/f Q 5 - �'3 ‘- ® til ( l/
<br /> A ( CONTACT EMAIL: ,/)v 'Sov.A6e s a 51,/e9rk S b �C'c 1 .1iC
<br /> BUILDING PERMIT APPLICATION ✓
<br /> Existing Use of Building: ', 5 (>o .. e4✓t,.; f) Contract Price of Work:$ q S 0, 0 Q
<br /> Proposed Use of Building: Heat Source: Gas ❑Electric 0 Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> l Uv. 5``) ) , r,_ _ -4-,=. c,, ,,9 e- J aye-, ----
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: New Addn Alteration _Repair Type of Project: _New Addn _Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C—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 /> 1 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/SUPPRESSION SYSTEM
<br /> Chemical or Water ' 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 1 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 18.2 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> J h4 PERMT Dlr �Ic
<br /> r ate//
<br /> Own- thorn-:Tg- Signat,r! Date (Revised 9/21/2016)
<br />
|