|
�(j � PERMIT APPLICATION II II ii
<br /> BUILDING J IlE!I'ECHANICAL/ PLUMBING /SIGN /SPRINKLER I DEMOLITION
<br /> "11P44 .7"1,44 cliwf,_ 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 I www.everettwa.gov/permits
<br /> (Blueor Staab Iflk Onily please), , PROJECT',SITE INFORMTI<O!1 , M ,: r
<br /> PROJECT SITE ADDRESS: 1 41 3 4 312-® S T wait/W A eitica PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> X > .z aR ,. st CONTACT INFORMATION
<br /> :: _ amu, �- - � .. ,. ., �� ,�..��,,,-�4.„ i=,tn , . ':.g,s-`st.xtPNN,r,,,ZSMZ5..':.,
<br /> OWNER NAME: /6 C i IC at aH h TENANT NAME(If Commercial): 1040/1 11)1Ce TAU`NO"'
<br /> OWNER MAILING ADDRESS: STREET 143 2g- NIC- 204, Si. D(P2
<br /> CITY Set•IxvV'e STATE LA ZIP 0
<br /> OWNER PHONE: ( zo ) ILIg - I OWNER EMAIL: E.ie- t FmeO TL.OV . 641,1
<br /> /
<br /> CONTRACTOR NAME: j1 /WV IN f t-I M
<br /> CONTRACTOR ADDRESS: STREET 3013 Z Z Mor ' (0t ()f'( i ,6C
<br /> CITY TCVCV41%. Wel STATE W01 ZIP iSZD3
<br /> CONTRACTOR PHONE: (IRS 472 " kV IV CONTRACTOR EMAIL; Pg-1m GIP €M Poi tG ' etrt+l1
<br /> CONTRACTOR LICENSE#(REQUIRED) PRIMA C M 1144 Q 9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) ,r
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR Q,6'ff-IER(Please Specify) t e Ce Gee
<br /> CONTACT NAME: CONTACT
<br /> CONTACT PHONE: ( at'S) 1.1%2".IV qt
<br /> WWII J"t cx, iettA,okon, CONTACT EMAIL: 14 Scar e q?3 E) CAMAr,1• ct rin
<br /> ' M x fBIIWDIWERMIT APPLICATION i F g r
<br /> Existing Use of Building: 1,00.3144 I$$14 C1WYCti15) Contract Price of Work:$ 3 DO 6c
<br /> Proposed Use of Building: C A UJ Heat Source: ❑Gas E3Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 21-Commercial ❑Industrial
<br /> Type of Project: ❑New DAddition ❑Remodel DRepair DT.I. ❑Sign ❑Sprinkler ❑Demolition a0'Change of Use
<br /> DESCRIPTION OF WORK:
<br /> e lit who n ot e tJ 64Imien ee, 4,466:001 11 le '-, 4S
<br /> ,4-cl� �c;r / I4r7/1" ,S^ , t� pvl� ui~I vi.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): t
<br /> r, nrMEC,HANI(CAL=PERMITAPPLICATION1 ,,z 4u,! "PLUMB$P G PERMIT.APPLICATION ,,
<br /> Type of Project: _Ngw _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 I 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 3 Sink(Service/Bar/Mop/etc.) Other:
<br /> 10-.000040:00010.0100:07W
<br /> Chemical or Water 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> Owner/Author'g'It gnature Date (Revised 9/23/2016)
<br />
|