Laserfiche WebLink
OVETTPERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /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 I(E)everettops@everettwa.gov i www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 61 i gC6.441 ST 5E PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision - Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Fret A,K Drt'scoi 1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t1 1 + c g44/1 Sr SE <br /> c- _,{/ <br /> ( 'efy STATE teof4 ZIP 98f 0 3 <br /> OWNER PHONE: 42.5 750 1+8 70 OWNER EMAIL: <br /> CONTRACTOR NAME: L.,l" i ` to tyl L <br /> CONTRACTOR ADDRESS: STREET 14 (roctaL 7 <br /> cIN STATE A_ ZIP g Z a I <br /> CONTRACTOR PHONE: 4 2 S 25 q, C::) 50 CONTRACTOR EMAIL: IBJ CI t ciryi,r't '(." (( Q •C0I"Y1 <br /> CONTRACTOR LICENSE#(REQUIRED): z 1 •-*01,6R 14-. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): iDto 4 g <br /> PRIMARY CONTACT: 0 OWNER I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:: CONTACT PHONE: L 26 259' �055D <br /> -Debt L CONTACT EMAIL:c)thig a ea a+t ,Corry <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 710 D 0 <br /> Proposed Use of Building: Heat Source: OGas Nectric ❑Other <br /> Building Type- APR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ENew ❑Addition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> ...... <br /> DESCRIPTION OF WORK: <br /> 1145-1-6.11 doc:116S5 IA-44-1- ponit-f <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New , Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of #of <br /> List of Fixtures_ List,of.Fixtures. List-of turas._..____-....__#of___.__._ _tistofFi�rtures <br /> Fixtures Ffxtur.s '- t <br /> 7=Txturars Fixtures <br /> sA/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 Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM W <br /> Chemical or Water I No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed!his 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:s made. <br /> and i comply with the State Contractors Law 18.27 RCW and 296.200A WA C. <br /> City of Everett Official Use Only <br /> PERMIT{ .....,n 3 <br /> Ow erlAuthortzed Age Signature Date (Revised 9/23/2016) <br />