|
1
<br /> elPPERMIT APPLICATION
<br /> /13UILDINGJ MECHANICAL/ PLUMBING)SIGN /SPRINKLER/ DEMOLITION
<br /> `---- —'" CITY OF EVERETT PERMIT SERVICES
<br /> viiiii
<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 /> PROJECT SITE ADDRESS:� �� l I� - � � �A t- � � �vv.�P+I-L IANA 982!
<br /> OPERTY TAX#:
<br /> LEGAL for new construction: Short
<br /> t Plat/subdivision Lot No. (attach copy of long legal description)
<br /> 77,14‘ 4v,vi IAA, c oo,vl „r Ay(7, CONTACT INFORMATION
<br /> OWNER NAME: CA, r. f"`A 4 '1)) TENANT NAME(If Commercial): l f r ).- ci i o3 / . 2<
<br /> OWNER MAILING ADDRESS: STREET 9 j / /6 L7 a Si-, 5/ a,-1-e_ 6 I 2_ (2),,,x 3c.7,3
<br /> CITY l 1111 I if �1 ,e t? V IA STATE v A ZIP / ?L7 12
<br /> OWNER PHONE: Z 06–�/fin -3 / OWNER EMAIL:3ad,, K; ryt,®6,}evia j1. COWL
<br /> CONTRACTOR NAME: A cxyl e_ C'anK � I c�vl,
<br /> CONTRACTOR ADDRESS: STREET I l o uo ,°,ve ;c e Of.
<br /> cry '� II STATE V j,4 ZIP t'Q I 1
<br /> CONTRACTOR PHONE: 2J3 ^6/9 777 3// CONTRACTOR EMAIL: (;LO.;�/)e_C,yi.5..f. ORnl , rt- 1,,K.,.
<br /> CONTRACTOR LICENSE#(REQUIRED): ,Z31III I SCC 603 Kiri OF EVERETT BUSINESS LICENSE#(REQUIRED): 61,?ill
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ( OTHER(Please Specify)Ten-cin+R,ss; /4.,hi// %j,- 5-4,,d;,.5
<br /> CONTACT NAME: CONTACT PHONE:?i.t9j.r5"" 169
<br /> c_ en.--, 4-41r /XcI, r).5 CONTACT EMAIL: ror -nc� ��c, s1
<br /> 1 .co✓pv.
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building:Co.;v1w a c0o;al Contract Price of Work:$ I 0, /c7O O
<br /> Proposed Use of Building:6,In0, .;oLl Heat Source: ❑Gas Dflectric ,❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ulti-Family-#of Units: Commercial 0 Industrial
<br /> Type of Project: ❑New ❑Addition DRemodelnEl Repair L,d'f.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:Demo ex,64iv1 �"r- %s'tcnnc�it`1 kA-41S, I(avMQ.-, 6i- i A4. 5i,1 k. `. cA I ''t-r-c"rvlal LL-45 -\ty
<br /> C�u+c_(c cn r' . (�
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: _New Addn _Alteration _Repair Type of Pr.'40•ct: _New _Addn _Alteration Repair
<br /> #of #of #of #of
<br /> List of Fixtures List of Fixtures Fixtures List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C–Air Handling Units Heat Pump T.-et ABackflow Preventer(Inside Bldg)
<br /> ForcedAirSystems Unit Heater : t Urinal
<br /> Gas Piping Boiler 1 a ory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration ower Floor Drain
<br /> Gas Fireplace Wood Stove itchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting k \ti,.hwasher Roof Drains
<br /> Clothes Dryer Hookups Other: lothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER I SUPPRESSION SYSTEM
<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 .$ n o V
<br /> O er�Au orized Agent, ti n fur ���/ ,' , D
<br /> p.
<br /> G-
<br /> g e ate (Revised 9/2 /2016)
<br /> V
<br />
|