Laserfiche WebLink
.- PERMIT APPLICATI&H <br /> /11111P <br /> "" BUILDING I MECHANICAL I 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> m <br /> (Blue or Black ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �. - 1 r - PROPERTY TAX#: s o <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ilea – .4 � TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET '"', apn f <br /> car STATE ice,.. ZIP -t gl/ <br /> z'' <br /> OWNER PHONE. ° OWNER EMAIL: 013 ( . :,' 40 ... • . <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: s - 4.1:60- S. (�f "�3 <br /> ci SrA`vt z" iv <br /> CONTRACTOR PHONE ,. CONTRACTOR EMAIL: .4,14( ,r S " <br /> • <br /> CONTRACTOR LICENSE#(REQUIRED): t'f 1 f)i 40 CITY OF EVERETT BUSINESS UCENSE#(REQ:' ,):, <br /> PRIMARY CONTACT: 0 OWNER = CONTRACTOR 0 OTHER(Please Specify) <br /> CO.TACT NAME: CONTACT PHONE: <br /> Cfl"- te. 1 if L.r(4 CONTACT EMAIL: no/ t` . <br /> BUILDING INFO RMATION <br /> Existing Use of Building: Contract Price of Work:$ ° lit e IA <br /> rIPoposed Use of Buildin•: Heat Source: OGas _ OElectric CDOther <br /> BUILDING USE: OSFR OTownhouse ODu'lex OADU DMuiti-Famil -#Units: OCommercial OAccessory Structure <br /> T pe of Pro'ect: El New ❑Addition ❑Remodel 'epair OT.I. OSi.n OS•rinkler ❑Demolition OChante of Use <br /> DESCRIPTION OF WORK: f /r, ° , <br /> 0"--0 ' rhe° <br /> s" > <br /> ASSOCIATED BUILDING PERMIT# if 9.licable: <br /> ECHANICAL PERMIT APPLICATION PLUMBING PERMI'r APPLICATION <br /> Fhrbrre Ferre Fixture List of Fixtures Fixture <br /> List of Fixtures List of F <br /> Count Count Count Count List of Fixtures <br /> NC .it Handling Units Gas P.=''g - Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler G .:-arise Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes D -r Heat Pump&Ductless Dishwasher 'Sink-Residential(kitchen,bath,bar) <br /> Duct System "emodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans("-sidenti.A Commercial Ventilatior Floor Drain Toilet <br /> Ekhaust Hood -LIMB Not Heat/AC s stem)gig <br /> Klose Bibb Carinal <br /> Exhaust Hood - . <br /> (T.:,,,,IVIIIIIIIIMI Water Heater / Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hoo. ;-aside Wood Stove interceptor-Sand/Oil Water Service(behind meter <br /> Forced Ai -terns Other. Medical Gas Water Valves or Fixtures_ <br /> Gas F.=placetlnsert/Log Roof Drains Water Heater <br /> SP`s NKL ER f SUPPRES'' .N S'YST'EM =,,• j= •r•r • • i. Other: <br /> Water , «•ressmon System No.of`Heads <br /> uTiemicai Suppression System ..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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> an. • '• State C. 'actors Law 18.;`:.RCW and 296.200A WAC <br /> 411116, <br /> d' City of Everett Official Use Only <br /> PERMIT#p 1 m q <br /> ;14 M <br /> I w <br /> Owner e i .nz ge ignature Date (Revised 10/10/2018) <br />