Laserfiche WebLink
re, 14-614)6 <br /> PERMIT APPLICATION <br /> "ION <br /> 1004/ <br /> ... BUILDING /MECHANICAL PLUMBING, I SIGN /S1 I K1 R/ DEMOLITION <br /> CITY OF[MERE]1'PERMI I SERVICES <br /> y 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)X25-257-51'i10 1 FAX 425-257-8857 ((E)eyeretteps@evorottwa.gov i �vww.evc;rottwa.gnv/perlTtits <br /> Dia or Black Ink Only Please)._ ....__e _. <br /> ( y PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1117 VMOAr212 AW PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> � m <br /> CONTACT INFORMATION <br /> OWNER NAME: 1 t P TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET n 1-7 LAyAn0A2,9 Ave <br /> CITYPV.e12-Wir STATE Wim- ZIP - _... <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: L-A p"- HA-1t,' t jP ` 1,frI ?.f. Pt,t <br /> CONTRACTOR ADDRESS: STREET I '6 t ag <br /> "' N <br /> ° <br /> ON :Y STATE Wer ZIP*3092* <br /> CONTRACTOR PHONE: 47-9 l °aril 1" CONTRACTOR EMAIL he i R 1,y j 1 toy trot•cowl <br /> CONTRACTOR LICENSE#(REQUIRED); L-A P12%1 PI I•I 5,0 PA-- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Q35�' <br /> PRIMARY CONTACT: 0 OWNER ..ErCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: t� CONTACT PHONE: 4-2-9 . ( •41.7- 7 <br /> IVit Gf-1 At 1i t 1 1 CONTACT EMAIL: he v t etarroptete4toravvi <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: tiOlVt Contract Price of Work:$ 1.11 ovo . t70 <br /> Proposed Use of Building: Heat Source: DGas 0 Electric ❑Other <br /> Building Type: .? SFR-Detached ❑SFR-Attached ❑Duplex ❑Iviulti-Family-#of Units: ©Commercial 0 Industrial <br /> Type of Project: ©New IJAddition .ZORemodel ❑Repair ❑T.1. DSlgn DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 0, M �. "s FP-Akelro, P>e it f l - %%. i 6,°N , i„.i 1`NerTA w w <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 #of <br /> List of Fixtures Lls€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 Sink(Service/Bar/Moptetc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> !Chemical or Water l No.of Heads <br /> ACKNOWLEDGEMENT:t have reviewed this application and confirm-the information contained herein ie 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 authorizedin writing from the <br /> Building Official before being authorized under any cjrcuttisiance_lam the owner,orf 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 298.200A WAC. <br /> City of Everett Official Use Only <br /> 114(4 <br /> I PERMIT .;�c lIP <br /> - •c 12,4$(b) <br /> Owner/Authorized Agent Signatu DateRevised9123/2016 <br /> 1 t <br />