Laserfiche WebLink
eiro____. <br /> PEE'MIT AtPPUIC IIIIIIII N <br /> BUILDING/MECHANICAL/ PLUM ;ING / , i; I /SPRINKLER/ P.EMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> 0Bh a or i✓lack Ink Only Please) Pt-.OJECT SITE INFORM TION <br /> r _. <br /> PROJECT SITE ADDRESS: QOM) 'C-b * ..p.Aj't., t 4. Wt64, cttft PROPERTY TAX#: 015143011/2W X36 <br /> LEGAL for new construction: Short Plat/subdivision i Lot No4(attach copy of long legal description) <br /> CONTACT INFORMATI!•N <br /> OWNER NAME: Dt -e Xl U C 5 TENANT NAME(If Commercial): 1 c .KO U S� <br /> OWNER MAILING ADDRESS: STREET rz9010l QVX,Vitir 4. u j 9 Li- <br /> / CITY _.,\I'Q.)(104. STATE IA.* ZIP gg90`L <br /> OWNER PHONE: (9U6- /�,3-- oboq OWNER EMAIL: GI yr /,u-/,0 `1 <br /> ; ( s 00onnor.CCM' <br /> CONTRACTOR NAME: (1),A.V\Pi <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: *OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 12.c‘ ,VqY_v��5 CONTACT PHONE: Set CO)��� <br /> CONTACT EMAIL: J <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ X50 <br /> Proposed Use of Building: c2-.-e \'YN Heat Source: ❑Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex LVlulti-Family-#of Units: 1 ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel EtRepair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: j�Vwo kr-4- l� <br /> ".JW 5}(0,--c_ 0 lr )k L) C,`�vet e5 `(� S.+S.+<J c---4-1/45 �r�lla*i <br /> V <br /> L —� �,50 P �,\r-e in �sl#Na. 0 d. V C Cu;�... <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 List of Fixtures #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures 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 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 <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 /> (2\41.A <br /> r� �jCitty off Eve(re�tt Offficial Usee OnlyG,7•. r\1 ,� d 1k <br /> t6 ' PERMIT LC�!v.I 9)02-00\ <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />