Laserfiche WebLink
PERMIT APPLICATION <br /> 41-en" BUILDING/ MECHANICAL/PLUMBING /SIGN /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)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 624 1 11_, Sr: 1(_OI PROPERTY TAX#: 2 eo s-/ I(: }HOZ' j <br /> LEGAL for new construction: Short Plat/subdivision �Ci Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: &6 A Am-TA VIS LL,CrENANT NAME(If Commercial): 7ope2- Hp g <br /> OWNER MAILING ADDRESS: STREET 7f421sL 01"77-ti sr SuiT - sh y @ Lam, CITY /�L , S IL ik lb STATE 1/A- ZIP j O0',7`jC) <br /> r <br /> OWNER PHONE: �_ 941 S'/Zj. OWNER EMAIL: Tvt./E Oepr -1Y-yP'kc/t.LEcrf'fE.e'(?m <br /> CONTRACTOR NAME: ken lb.) -- s-re_vC;l' P L L. <br /> CONTRACTOR ADDRESS: -1T-IiSTREET A7 42J, S2Si ,- Su i G zo <br /> CITY f J ( y Z 3 L JT7 - STATE �"' ZIP q 010 <br /> CONTRACTOR PHONE: '/2- 2 8 i..- G2.� f CONTRACTOR EMAIL: <br /> � C,A„„y 4(e,,,,,,,:,/.6,41 <br /> CONTRACTOR LICENSE#(REQUIRED): !'G)r Fv /S*g3 s CITY OF EVERETT BUAESS LIOENSE#(R QUIRED): <br /> PRIMARY CONTACT: 0 OWNER 'EONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: enCONTACT PHONE: e (_ 66 G <br /> ``' it Ci "� CONTACT EMAIL: t,_ 3 l ci; i .C.ofI!') <br /> BUILDING PERMIT APPLICATION 0 <br /> ��f` <br /> Existing Use of Building: Contract Price of Work:$ $2-01000 <br /> Proposed Use of Building: Heat Source: ❑Gas @Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: DCommercial @industrial <br /> Type of Project: ❑New @Addition ❑Remodel ❑Repair OT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> l PI5111-1(„1-x'70/•-- O Neter.' Mft-r-)v -A-r..1-z.)R --( f10,14 - <br /> tN12) Ex,tcrid Ca 5L411— II-4 Mftri. t-tonitiC Pe."-- 6-11-4° 5E- Ad"- <br /> - 11 J <br /> ASSOCIATED BUILDING PERMIT#(if applicable): A'I401%. G I/irTFi- - <br /> t S -S f c'w' -'-- Dex-14 <br /> I, , ,MECI ANJCA- PERMIT APPLICATION.. ,I.I.,,_, , , _ PLUMBING PERMIT APPLICATION ... I , <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: New _Addn Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of 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 n <br /> Gas ..t'/�I'LL Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) 9 Other:VV-014-61( <br /> SPRINKLER/SUPPRESSION SYSTEM 6)92/(AMP? <br /> �� ���� <br /> Chemical or Water ' 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 /> City of Everett Official Use Only <br /> '1,---J <br /> g. 17.— <br /> . 17.— 0 PERMITO \,' �,f�.'--°M <br /> Own Authorized Agent Signet a Date (Revised 9/23/2016) <br />