Laserfiche WebLink
grrPERMIT APPLICATION <br /> BUILDI■ MECHANICAL I PLUMBING I SIGP 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION f <br /> PROJECT SITE ADDRESS: 4722 1/ � sj� /7,&..e�� PROPERTY TAX#:,7d o9f yo,jgaO 9tV <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: D � V TENANT NAME(If Commer. al):S-? r, <br /> J (. � LO Q <br /> OWNER MAILING ADDRESS: STREET /,2 &C( /��' Ge'6(7 <br /> CI1 Y "„, (,f4 STATE OF / ZIP I( 7/,f� - <br /> OWNER PHONE: 7/(32 / <br /> 3Z •"61G67 OWNER EMAIL: , , 1 /a P! )/ti <br /> • <br /> CONTRACTOR NAME: - -a i , ' i /we"-, .. OLJ N-I C. -.Ta------ <br /> CONTRACTOR ADDRESS: STREET ,,/ -7G-4(' (Y ,e e�� <br /> 902,---7/1--CITY //� CL/CL�,/ 'Y/ STATE <br /> ���( -`�/ ZIP 61,a 7...C- <br /> (1../. <br /> � <br /> CONTRACTOR PHONE: vie 2//66/ /� CONTRACTOR EMAIL: G%'17ae�i 4-//4 - �" d <br /> CONTRACTOR LICENSE#(REQUIRED): �G (GvGrL![� . G(/ /o C CITY OF EVERETT BUSINESS LICENSE#(REQUIR ): <br /> PRIMARY CONTACT: P;pWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONT T NAME• 7 CONTACT PHONE: 4/,,2,1-7/7/46 <br /> 'i./// ._,......_ CONTACT EMAIL: , " <br /> BUILDING PERMIT APPLICATION nn <br /> Existing Use of Building: T :v, 66/-2,,,,,,� „ ,, a. Contract Price of Work:$ 2 .5 aaa <br /> Proposed Use of Building:LI r /Cc -1;1.1Aaery-e__ Heat Source: *as ❑Electric DOther ��,,.�� <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Familyof Units: ❑Commercial ,r^tllndustrial <br /> Type of Project: ONew DAddition Remodel El Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> 7 <br /> DESCRIPTION OF WORK: /p <br /> V- --- ,' e c � se-� -/��ZC/a'lPite Citi liteer/ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_ Addnilteration \ Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #°f List of Fixtures List of Fixtures #°f List of Fixtures #of 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 I 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 /> s City of Everett Official Use Only <br /> 2� ��G PE.` C,90 2,- 049 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> 61..... . <br />