|
I' I III-477 PERMIT APPLICATION
<br /> BUILDINIJ HV1ECHANICAL/ PLUMBING /SIGI RINKLER/ 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 /> {BlOe r BId'CCk tri*0.nly PIoas) .".,f i. :PROJEC'T:SI ' INF II RATION i ta, , . v t' a Y; tea£- s . . _ ., ..
<br /> PROJECT SITE ADDRESS: ILD 4.1.Ces140 Rd#3144 Eve rck,w 6 q 3 loci PROPERTY TAX#: Of)bIliD0000 Soo
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ' " CONTACT;INFORMATION,. '` w
<br /> OWNER NAME: OA ev'Cu"yf Po,rL FOU O y� j L1_ TENANT BUSINESS NAME(Commercial): Pok✓k../2.0
<br /> OWNER MAILING ADDRESS: STREET il 2., 00 �„j'I lS��i,f t. l`f(%, 5- ZsJ
<br /> CITY LAS/ vt kS STATE CA4 ZIP Qa02.c
<br /> OWNER PHONE: 006) L I4 — ?®3 OWNER EMAIL: S pal(Ate e-6nAokmei,(off 03
<br /> CONTRACTOR NAME: Uteks.k.415CAA-e1p{)S2 s D.6,A S 6-AU Pi2- N.ea /Lk eat/tqle Sic ue s/ Won ro e
<br /> CONTRACTOR ADDRESS: STREET 17 3® 'fii(aD 4 /We, S-r to I `
<br /> CITY S it 06 OrliSi STATE 1,....),A' ZIP 1 '25 0
<br /> CONTRACTOR PHONE: t4 -Sol-5 5 1S CONTRACTOR EMAIL: 3 Shl&ISO n Se(Uprb Q W%et±vOck v CO en
<br /> CONTRACTOR LICENSE#(REQUIRED) j Ee4 P es g 4'a RD CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 05"2.2.‘5� ..,, . . .. ._. ... ,. . .._ b� . . _�A. ,W, . ,_.� �.. ._. __ . . ,- •-
<br /> PRIMARY CONTACT: 0 OWNER px CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 15 -2509—s5ct 5
<br /> J e44 SzfreV1 3 n CONTACT EMAIL: 1 SD re+nson� l:
<br /> S ereL .Co r-%
<br /> •
<br /> ,.� gttfjitia4:-AZ*Ra;gr.nPWABUTLDINGWFortMA*I, Ntig�� .tRt,nrtP=. A; a i ,n
<br /> Existing Use of Building: ReSititAe.0 ,mr Mt441,- oy-% Contract Price of Wor $ ..-- T ZO Co li 'it
<br /> Proposed Use of Building: Q.uS i ce M. 4-i1&v✓' Heat Source: ❑Gas lectric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU jp,1ulti-Family-#Units: I;t '71 •mmercial $A -ssory Structure
<br /> Type of Project: New ❑Addition ERemodel ❑Repair ❑T.I. ESign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: rb(i'e t‘+ . '1\16S¢J c)c)" vvatine.t.riY3 ) r-asv o-At A..- ,1c( (2cp taCt. a('rt4ed
<br /> ei4,Nec4 c ck, p Qj.c. ,,�\-,1
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):-r ' A 0'3-®02
<br /> q'MEGHANICAI.e'P'EItMI I APPLICAI ION .t >.' 2 . _f ``, .a < PI:UMBINNG;PERMIT APPI:ICATION
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures . Count List of Fixtures
<br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> -
<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 /> t Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet
<br /> V 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 /> 'L 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 /> Y= SPRINK1 ER;L SLJ'PPRESSION SYSTEII)I , Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System I 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 I am authorized by the owner of this property to perform the work for which application is made,
<br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> 4 PE
<br /> S--/ 7 --I et l'In't0 3 ,-- po2-
<br /> Owner/Aut .riz,. ('gent Signature Date (Revised 10/10/2018)
<br />
|