Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> 1444 CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/perrnits <br /> ._f_ ..; P_.ROJ,ECT SiTE'INFORMATION <� <br /> PRQ,�F�T+SITE lows:SS: jiV P_ � - PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ;.;. r :';,CONTACT INI ORMAsTION `_. . !: . . ' <br /> OWNER NAME: zc dA 81,01Atoi TENANT, NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET £+i19( 3154 Ave S i <br /> CITY rt/Wni' STATE ZIP '7203 <br /> OWNER PHONE: `/Z5) 6(0 — 722'1 OWNER EMAIL: G 15% ca i c/9 . (Doi..._..................... . <br /> CONTRACTOR NAME: ReV(LC7 iU i Am/ /7i q <br /> CONTRACTOR ADDRESS: STREET 670Y die, <br /> t q y PL N1 ' J /j�jn�J <br /> city g :iv)ire, STATE ha <br /> ii ZIP(fl f /0 <br /> CONTRACTOR PHONE:(i./25) 320--�? s CONTRACTOR EMAiL: S �5Grrl l e y V i,",/l i/aGl,+ <br /> CONTRACTOR LICENSE#(REQUIRED): R£5O(,P AL-flit' fq CITY OF EVERETT BUSINESS LICENSE#( QUIRED): ""74-40q <br /> PRIMARY CONTACT: L✓J OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: zteGI 8vown CONTACT PHONE:(25) 610 -722 <br /> CONTACT EMAIL: 2L C ,,�I <br /> G I�/`� Cie (� , i0"4.i <br /> BIESSOMENEMENIZEISITOI010140.00010*0-00010,00MEMSEMEISMENZBECO <br /> Existing Use of Building: 1?63ifX P,4[.e 5"igl2 Contract Price of Work:$ 2r000,0) <br /> Proposed Use of Building: 5' ,j c J Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached 11 'SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New LT Addition f2fRemodei ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: -tom_3 fi <br /> "tell l) ilk,1 r 1 C�, L. <br /> ly 4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECH IN1GAL PERMi0:PPLICAT110N_ , .,__,. _ PLUMR1NG,tPERMiT_APPLiCATION ;;:;,_ . :WS <br /> Type of Project: _New_ Addn Alteration Repair Type of Project: New Addn Alteration _Repair <br /> #of #of #of • #of 1 <br /> List of Fixtures List of Fixtures List of Fixtures 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 /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan I Sink(Service/Bar/Mop/etc.) Other: <br /> MIRSPRINKLER 1'SUPPRE010 SYS relift , <br /> Number 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 onty 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 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 /> 2/5111 6 <br /> PERMIT# (ge ? y 0 <br /> w u' rized Age re/� Dat (Revised 10/12/2015) <br />