Laserfiche WebLink
• + 6oZ --aye <br /> PERMIT"APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING I SIGN I S RINKLER/ DEMOLITION <br /> 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 I www.everettwa.gov/permits <br /> PROJECT SITE;INFORMATION <br /> 777777 , <br /> i1V24 <br /> JE SITE ADD SS: PROPERTY TAX#: <br /> PI <br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br /> - _. . ::CONTA6T INFORMATION <br /> OWNER NAME: f31 12JL-N 1 Y� a TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET Z °� <br /> CITY <br /> v'•� STATE W Y`t' ZIP G �+ <br /> CONTRACTOR PHONE: 3�6- CONTRACTOR EMAIL: 2 eo C�C - e C t �1L 2 <br /> M I <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): V V2 J <br /> PRIMARY CONTACT: '°OWNER ❑CONTRACTOR E7 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 360 <br /> 2 N I I< CONTACT EMAIL: <br /> BUI;LDINC�,'PERMIT APPLICATyON <br /> Existing Use of Building. Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex []Multi-Family-#of Units: QCommercial OIndustrial <br /> Type of Project: EINew OAddition E1Remodel EIRepair OT.1. E7Sign E7S rinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .. . ,. <, � GCATI <br /> MECH:ANIAL PERMIT APPLICATION PLUMBING P PP ON. <br /> Type of Project: New_ Addn _Alteration _RepairyP J <br /> T e of Project: _Ne Add _Alteration _Repair <br /> #of #of #of List of Fixtures of List of Fixtures <br /> List of Fixtures List of Fixtures Fixtures <br /> Fixtures Fixtures Fixtures <br /> A/C-Air ling Units Heat Pump <br /> Hand . 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 <br /> 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 f SUPPRES:SIION SYSTEM <br /> Number of Heads -A <br /> ACKNOWLEDGEMENT.,t 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. City of Everett Official Use Only <br /> PERMIT# <br /> Date s (Revised 10/12/2015) <br /> Owner/Authorized Agent Signature � (;--��00 <br />