Laserfiche WebLink
PERMIT APPLICATION <br /> (0—iiliArrBUILDING / MECHANICAL/ PLUMBING I SIGN I 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 1(E)everetteps{»teverettwa.cdov 1 www.everettwa.govipermits <br /> {Bios or Black Ink Only Please} PROSECT 81TE-1h1I?taEtMA7'iON <br /> PROJECT SITE ADDRESS: p� a / 7 .*Th 5 5 <br /> LEGAL for new construction: Short PlatdsuGdtvislon ! PROPERTY TAX#: <br /> Lot No. (attach copy of long legal description) <br /> V <br /> �f Ct/ CONTACT INFORMATIONtON - <br /> OWNER NAME: Y Ic,l� (e 1 -- <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 212_t 7L-12111 ST SE <br /> g {O <br /> f <br /> cry + - ZIP C3 203 <br /> '425 STATE vu <br /> OWNER PHONE: <br /> �� OWNER EMAIL: <br /> CONTRACTOR NAME: in . '♦ in in L <br /> CONTRACTOR ADDRESS: STREET 14 (oro1 ..c .ua0... ,Jj <br /> cm,' er (1, I <br /> STATE r +_ Z:P e .. <br /> CONTRACTOR PHONE: L-'25 tC�� CONTRACTOR EMAIL <br /> CONTRACTOR LICENSE (t1 c�t,1R p): t- arl t' f V 4.3"),V,1 .6oryi <br /> __ CITY OF E ERETT BUSINESS LICENSE#(REQUIRED) ID QCs <br /> PRIMARY CONTACT: 0 OWNER IYCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAMEj -Z�"-� ZSq faZ <br /> CONTACT PHONE: �� <br /> Delo3o Led <br /> ) <br /> CONTACT EMAIL:dtbja u2e t_,„ "j L Co <br /> ni <br /> BUILDING PERMIT APPLICATION- �' 3 <br /> Existing Use of Building; <br /> Contract Price of Work: $ 7 750, <br /> Proposed Use of Building. <br /> _ Heat Source: OGas Electric DOther _ <br /> Building Type: 'FR-Dot shed ❑SFR-Attached ❑Dy dox Q upti_ amity_ of Units. ❑Commercial DIndustrlal <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign DSprinkler ❑Demolition OOhan;e of Use <br /> DESCRIPTION OF WORK. <br /> ASSOCIATED BUILDING PERMIT# if applicetate) <br /> MECHANICAL PERMIT APPLICATION <br /> 777;77;;;;;7"—N77-77d----A77.77-72-71# _ n _ r PLUMBING PEFtAdd <ApPLICation <br /> of Type of Project: New `Addn _Alteration _Repair <br /> �f�#_afEixtures �n1 #of <br /> Futures'— Ust of. lxtimes ._ gist-of-Fixtures. .—.- 8 of <br /> Fixtures Fixtures Vat-of Fixtures <br /> NC-Air Handling UnI(s Heat Pu1np Toilet Fixtures <br /> Forced Air Systems Unit Heater <br /> Backflow Preventer(insu e Ding) <br /> Gas Piping Bathtub Urinal <br /> Boiler L v2 ry tVVash E3asin <br /> Wafer F10-7-Z7------7---TR } Drinkin E <br /> ekigeration q ouniain <br /> Gas Fire [ace Shower <br /> p Wood Stove i Floor drain <br /> Gas Rama Kitchen Sink;+t L7is oral Grease Trap <br /> Ductlnr., i7Pshwasher <br /> Cfo£hes f-3,yar Hor�kUp i Other- Roof Fralns <br /> Renge tnITt1 Clothes Washer Medical Gas <br /> ,xaust Fan Water Heater Other: ' <br /> Sink( ervicet8artlVlopletc.j Other: <br /> SPRINKLER f SUPPRESSION SYSTEM <br /> Chemical or Water No.'"--- 71-17M7"-- <br /> ACKNO WLLOGEMEt t have revrowed lh a ap,J,'ication and sordew(tie inforrnation contained herein i;4.lrue and correct. WW1'done Aursudr,1 to this paunit <br /> current federal,stale,and local law, Tile granting of a permit only authorizes approved walk end no deviations therefrom.Do atiorrs rnirstfirst he eothmtzed t writing <br /> building Official before being authorized lander any circumstance.I am the owner art am autlhotflea sy the owner of this property to perform the work for which must <br /> with nr , <br /> and 1 comnty with the Siete Contractors Law 18.27 ROW and 298,200A WA C. <br /> if ny from the <br /> City of Everett Official Use Only <br /> f } PER T • <br /> ,AA LiCw,er/Authorized Age Signature <br /> � �� �� 1/4 �._ <br /> Date (Revised 9/2312016) 0 <br />